超声引导下肌间沟臂丛神经阻滞经导管注射0.75%罗哌卡因的有效剂量研究  

The Effective Dosage of 0. 75% Ropivacaine Infected by Catheters for Ultrasound-guided Inter-scalene Brachial Plexus Nerve Block

作　　者：陈学均[1] 万永灵[1] 温开兰[1] 梁涛[1] 林涛[1] 李鹏[1] 

机构地区：[1]四川省医学科学院.四川省人民医院麻醉科,四川成都610072

出　　处：《四川医学》2016年第2期154-157,共4页Sichuan Medical Journal

摘　　要：目的探讨超声引导下肌间沟臂丛神经阻滞经导管0.75%罗哌卡因的有效剂量。方法选取我院行肌间沟臂丛神经阻滞下肩关节镜手术患者38例,采用Dixon序贯法进行试验,超声引导下肌间沟臂丛神经阻滞经导管注射0.75%罗哌卡因起始容量为15m L,若阻滞效果完全,则下一例减少1m L;若阻滞效果不完全,则下一例增加量1m L。采用Probit概率单位回归法计算ED50及其ED95。并观察感觉和运动阻滞的起效时间,维持时间。结果经导管注射0.75%罗哌卡因在超声引导下肌间沟臂丛神经阻滞的概率单位模型为Probit（P）=-6.186＋3.925（ln剂量）,ED50为4.836（3.826~5.584）m L,ED95为7.353（6.111~19.616）m L。剂量从4m L升至6m L时,成功阻滞率由25%升高至75%。感觉阻滞起效时间中位数5min（最小5min,最大20min）;运动阻滞起效时间中位数10min（最小5min,最大15min）;阻滞维持时间（8.9±3.7）h。结论通过建立Probit概率单位回归模型,对于超声引导下肌间沟臂丛神经阻滞,经导管注射0.75%罗哌卡因的95%有效剂量为7.353m L,剂量从4m L升至6m L时,可显著提高阻滞成功率。该技术在肩关节镜手术中具有较好临床应用效果。Objective To determine the effective dosage of 0. 75% ropivacaine infected by catheters for ultrasound-guided inter-scalene brachial plexus nerve block.Methods 38 cases of patients undergoing arthroscopic shoulder surgery via ultrasoundguided inter-scalene brachial plexus nerve block were accepted.Dixon sequential method was used in the test.The initial volume of0. 75% ropivacaine infected by catheters for ultrasound-guided inter-scalene brachial plexus nerve block was 15 ml.If the effect was complete,the next case could decrease 1ml; If the effect was not complete,the next case would increase by 1m L.ED50 and ED95were calculated using the probit regression method.The onset time and duration of block of sensory and motor were observed. Results Probit model of 0. 75% ropivacaine infected by catheters for ultrasound-guided inter-scalene brachial plexus nerve block was Probit（ P） =-6. 186＋3. 925（ in dose）,ED504. 836（ 3. 826-5. 584） m L,ED957. 353（ 6. 111-19. 616） m L. Rate of successfully block increased from 25% to 75% with the dosage increasing from 4m L to 6m L.Median of onset time of sensory block was 5min（ minimum5 min,maximum 20min） and median of onset time of motor block was 10min（ minimum 5min,maximum 15min） 。The block maintained（ 8. 9±3. 7） h.Conclusion With the establishment of Probit probability unit regression model,the effective dosage of 0. 75%ropivacaine infected by catheters for ultrasound-guided inter-scalene brachial plexus nerve block was 7. 353 m L.Rate of successfully block significantly increased with the dosage increasing from 4ml to 6m L.The technique had a good effect on clinical application in the arthroscopic shoulder surgery.

关 键 词：超声引导 肌间沟臂丛神经阻滞 罗哌卡因 半数有效量 

分 类 号：R614[医药卫生—麻醉学]