相同剂量不同浓度罗哌卡因行肌间沟臂丛阻滞对膈肌功能的影响  

A study on diaphragm function after interscalene brachial plexus block using a fixed dose of ropivacaine with different concentrations

作　　者：翟文雯 王雪冬[1] 李民[1] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,100191

出　　处：《中华医学杂志》2016年第28期2229-2233,共5页National Medical Journal of China

摘　　要：目的比较相同剂量局麻药稀释成两种不同浓度容量行肌间沟臂丛神经阻滞对膈肌麻痹发生率、肺功能及镇痛效果的影响。方法经北京大学第三医院伦理委员会批准，选择2013年11月至2014年4月于北京大学第三医院择期行肩关节镜手术患者60例，按随机数字表法将患者随机分为两组：全麻诱导前随机应用0.5%罗哌卡因10 ml（A组）和应用0.25%罗哌卡因20 ml（B组）行超声引导下肌间沟臂丛阻滞。记录阻滞30 min后膈肌麻痹发生率、肺功能和脉搏氧饱和度的改变情况。阻滞后4、8、24 h评估患者疼痛评分，记录补救镇痛和睡眠情况。结果两组患者臂丛阻滞后30 min膈肌麻痹发生率分别为67%和70%，差异无统计学意义（χ2＝0.077，P〉0.05）。两组患者臂丛阻滞后30 min用力肺活量分别降为阻滞前的（78±16）%和（80±18）%，差异无统计学意义（t＝0.435，P〉0.05），1秒用力呼气容积降为阻滞前的（85±16）%和（78±22）%，差异无统计学意义（t＝1.472，P〉0.05），脉搏氧饱和度分别下降1（0～3）%和2（0～3）%，差异无统计学意义（Z＝－0.538，P〉0.05）。两组患者阻滞后4、8、24 h疼痛评分以及补救镇痛、睡眠情况和满意度差异均无统计学意义（均P〉0.05）。结论应用0.5%和0.25%的50 mg罗哌卡因行肌间沟臂丛阻滞在膈肌麻痹发生率、呼吸功能改变和术后镇痛方面的效果相似。Objective To compare the effect of interscalene brachial plexus block （ISBPB） on the incidence of diaphragmatic paralysis, respiratory function and post-operative pain control using same dosage of local anesthetics diluted into two different volume and concentrations. Methods Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing elective arthroscopic shoulder surgery in Peking University Third Hospital from November 2013 to April 2014 were randomly allocated into two groups according to random number table method： before induction of general anesthesia, uhrasound-guided ISBPB was performed using 0. 5% ropivaeaine 10 ml （ Group A） or 0. 25% ropivacaine 20 ml （ Group B）. The incidence of diaphragmatic paralysis, respiratory function and reduction of pulse oxygen saturation at 30 min post-block were recorded and analyzed. Patients were interviewed at 4, 8 and 24 h after block for numerical rating pain score, rescue analgesics requirement and sleep quality. Results There were no statistically differences between group A and group B for the incidence of diaphragmatic paralysis at 30 min after block （67% vs 70%, X= =0. 077, P 〉0. 05）. The change of forced vital capacity （（78 ± 16）% vs （80 ± 18） % , t = 0. 435, P 〉 0. 05 ） , the change of forced expiratory volume in 1 second （ （ 85±16） % vs （78±22）%, t =1.472, P〉0.05） and the reduction of pulse oxygen saturation （1（0-3）% vs 2 （0- 3）%, Z = -0. 538, P 〉 0. 05 ） showed no significant differences between the two groups at 30 min after block. There were no statistically differences in terms of the numerical rating pain score, rescue analgesics requirement and sleep quality at 4, 8 and 24 h after block （ all P 〉 0. 05 ）. Conclusions The use of 0. 5% and 0. 25% ropivacaine 50 mg for interscalene block provides similar effect on the incidence of diaphragmatic paralysis, changes in respiratory function and postoperative analgesia.

关 键 词：神经肌肉阻滞 臂丛 肩关节 膈神经 剂量效应关系 药物 

分 类 号：R614.2[医药卫生—麻醉学]