不同浓度罗哌卡因用于超声引导下锁骨上臂丛神经阻滞麻醉中的阻滞效果及对心肌的影响  

Effect of Ropivacaine with different concentrations on blocking effect and myocardial muscle in ultrasound guided brachial plexus block

作　　者：杨亚雯[1] 金晓菲[1] 朱国汉[1] 金鑫[1] YANG Ya-wen; JIN Xiao-fei; ZHU Guo-han(Department of Anesthesia, The First Affiliated Hospital of Suzhou University, Suzhou Jiangsu 215006, China)

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《临床和实验医学杂志》2018年第21期2342-2345,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金青年基金支持项目(编号:81601666)

摘　　要：目的分析不同浓度罗哌卡因用于超声引导下锁骨上臂丛神经阻滞麻醉中的阻滞效果及对心肌的影响。方法采用前瞻性研究的方法,选取2015年8月至2018年1月苏州大学附属第一医院行超声引导下锁骨上臂丛神经阻滞麻醉的患者270例,按照随机数字表法将患者分为三组:A组罗哌卡因浓度为0. 300%,B组罗哌卡因浓度为0. 375%,C组罗哌卡因浓度为0. 500%,均为皮下注射,每组患者90例。对比三组患者麻醉起效时间、镇痛维持时间、运动功能恢复时间、麻醉效果;观察给药前及给药后24 h时患者血清肌钙蛋白(CTn I)、肌酸激酶同工酶(CK-MB)变化分析其对心肌的影响;记录不良反应发生率。结果 (1)A组、B组、C组麻醉起效时间分别为(13. 19±1. 14) min、(8. 16±0. 91) min、(5. 16±1. 01) min,A组最长; A组、B组、C镇痛维持时间分别为(6. 87±1. 23) h、(8. 97±1. 26) h、(7. 23±1. 05) h,A组最短; A组、B组、C组运动功能恢复时间分别为(5. 46±1. 02) h、(7. 16±0. 93) h、(12. 30±1. 22) h,A组最短。三组患者以上指标比较,差异均具有统计学意义(P <0. 01)。(2)C组麻醉效果优率(100. 00%)较B组(88. 89%)和A组(83. 33%)高,C组良率(0. 00%)较B组(11. 11%)和A组(27. 78%)低,比较差异均有统计学意义(P <0. 01)。(3)给药24 h后,三组患者血清cTnI、CK-MB均显著升高,其中A组最低,之后依次为B组、C组,比较差异均有统计学意义(P <0. 01)。(4)三组患者均无明显不良反应发生。结论罗哌卡因用于超声引导下锁骨上臂丛神经阻滞麻醉时,其浓度为0. 375%时较合适,既能满足手术需求,发挥好的麻醉效果,又能减少对心肌的影响,安全性较高。Objective To analyze the effect of different concentrations of Ropivacaine on blockade of brachial plexus under ultrasound guidance and its effect on myocardium. Methods A prospective study was conducted to select 270 patients underwent ultrasound-guided anesthesia with supraclavicular brachial plexus block during August 2015 to January 2018 in this hospital. They were divided into three groups according to random nuumber table method, each group had 90 patients. The ropivacaine concentrations were 0.300%, 0.375% and 0.500% in groups A, B and C respectively. The onset time of anesthesia, duration of analgesia, recovery time of motor function and anesthetic effect were compared. To observe the changes in serum levels of troponin （CTnI） and creatine kinase isoenzyme （CKMB） in patients before and 24 hours after administration and their effects on myocardium were compared, and the incidence of adverse reactions were recorded in these 3 groups. Results ①The effective durations of anesthesia in group A, group B and group C were （13.19±1.14） min, （8.16±0.91） min and （5.16±1.01） min respectively, and the longest was group A. The analgesia durations for group A, group B and group C were （6.87±1.23） h, （8.97±1.26） h and （7.23±1.05） h, respectively, and Group A was the shortest. The recovery periods of motor function in group A, group B and group C were （5.46±1.02） h, （7.16±0.93） h and （12.30±1.22） h, respectively, and the shortest one was group A. The above indicators of these three groups were compared, and the difference was statistically significant （ P 〈0.01）. ③Serum levels of CKMB and cTnI were significantly increased in all three groups in 24 h after administration, with the lowest in group A, followed by group B and group C, there was significant difference among these three groups （ P 〈0.01）. ④No significant adverse reaction occurred in thesse three groups. Conclusion When ropivacaine is used for ultrasound-guided brachial plexus block anest

关 键 词：锁骨上臂丛神经阻滞麻醉 超声引导 罗哌卡因 阻滞效果 心肌 

分 类 号：R614[医药卫生—麻醉学]