超声引导下不同剂量罗哌卡因肌间沟臂丛神经阻滞的效果对比分析  

Comparative Analysis of Effects of Ultrasound Guided with Different Dose of Ropivacaine Interscalene Brachial Plexus Block

作　　者：王琳琳[1] 张雷[2] 陈恩琪[1] 刘美含[1] 石卫东[1] 

机构地区：[1]吉林大学中日联谊医院超声科,长春130033 [2]吉林大学第二临床医院神经内科,长春130041

出　　处：《医学研究杂志》2017年第4期93-95,99,共4页Journal of Medical Research

基　　金：吉林省科技发展计划项目(20100726)

摘　　要：目的对比超声引导下不同剂量罗哌卡因肌间沟臂丛神经阻滞的效果。方法采用前瞻性研究方法,2012年8月~2016年2月选择在笔者医院进行上肢手术的患者92例,两组都给予超声引导下罗哌卡因肌间沟臂丛神经阻滞,观察组与对照组各给予0.3%、0.4%的罗哌卡因20ml,记录两组的阻滞效果与并发症发生情况。结果观察组的桡神经、尺神经、正中神经与肌皮神经的感觉阻滞起效时间分别为9.11±1.23、7.20±1.33、8.20±1.33和6.92±1.00min,都明显少于对照组的11.34±2.91、9.67±2.01、9.98±1.12和7.92±1.94min(P<0.05)。观察组麻醉效果良好率为97.8%,对照组为82.6%,观察组的麻醉效果良好率明显高于对照组(χ~2=3.204,P<0.05)。观察组术后24h内的嗜睡、呼吸抑制、恶心、呕吐、烦躁等并发症发生率为10.9%,对照组为37.0%,观察组明显少于对照组(P<0.05)。观察组术后4、12与24h的疼痛评分都明显低于对照组(P<0.05)。结论超声引导下肌间沟臂丛神经阻滞可达到理想的臂丛神经阻滞效果,而低剂量罗哌卡因的应用能加快神经感觉阻滞起效时间,减少术后并发症的发生,更好的发挥镇痛作用,值得临床上使用。Objective To compare the effects of ultrasound guided with different dose of ropivacaine interscalene brachial plexus block. Methods By a prospective study method, from August 2012 to February 2016, 92 patients with upper extremity surgery in our hospital were selected, Patients in two groups were given ropivacaine muscle interscalene brachial plexus block guided by ultrasound, and those in the observation group and control group were given 0.3% and 0.4% ropivacaine 20ml. Block effect and complications of two groups were recorded. Results The radial nerve, ulnar nerve and median nerve and musculocutaneous nerve sensory block onset times in the observation group were 9.11±1.23, 7.20±1.33, 8.20±1.33 and 6.92±1.00min that were obviously less than those of the control group of 11.34±2.91, 9.67±2.01, 9.98±1.12 and 792±1.94min （P 〈 0.05）. In observation group, anesthesia effect good rate was 97.8%, and in the control group,itwas 82.6%. Anesthesia effect of the observation group was significantly higher than that of the control group （χ^2=3.204, P 〈 0.05）. In the observation group, the incidence of nausea and vomiting, irritability, drowsiness, respiratory depression and other complications after operation were 10.9%, the control group was 37.0%. The observation group was significantly less than the control group （P 〈 0.05）. The pain scores of 4h, 12h and 24h after peration in the observation group were significantly lower than those in the control group （P 〈 0.05）. Conclusion Ultrasound guided ropivacaine interscalene brachial plexus blockcan achieve the ideal of the brachial plexus block effect, and the application of low dose ropivacaine can accelerate the onset time of sensory block in nerve, reduce the incidence of postoperative complications. It has better exert analgesic effect that is worth clinical use.

关 键 词：罗哌卡因 肌间沟臂丛神经阻滞 剂量 疼痛 

分 类 号：R614[医药卫生—麻醉学]