不同局部麻醉药物配伍对腕管综合征患者神经阻滞效果的临床研究  

Clinical study on the effect of different local anesthetics on nerve block in patients with carpal tunnel syndrome

作　　者：徐兴国 陈情忠 付慧敏 邢树国 孟蓓[4] 杨建平[1] Xu Xingguo;Chen Qingzhong;Fu Huimin;XingShuguo;Meng Bei;Yang Jianping(Department of Anesthesiology,the First Hospital Affiliated to Suzhou University,Suzhou 215006,China;Department of Hand Surgery,Affiliated Hospital of Nantong University,Nantong 226021,China;Medical College of Nantong University,Nantong 226019,China;Department of Anesthesiology,Affiliated Hospital of Nantong University,Nantong 226021,China)

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215006 [2]南通大学附属医院手外科,南通226021 [3]南通大学医学院,南通226019 [4]南通大学附属医院麻醉科,南通226021

出　　处：《中华手外科杂志》2019年第6期432-435,共4页Chinese Journal of Hand Surgery

摘　　要：目的不同局麻药物配伍用于腕管综合征患者的神经阻滞,观察对神经阻滞效果及术中出血情况的影响。方法60例择期行腕管综合征患者,采用随机数字表法随机分为4组(n=15),即利多卡因+肾上腺素组(A组),利多卡因+右美托咪定组(B组),罗哌卡因+肾上腺素组(C组),罗哌卡因+右美托咪定组(D组)。观察四组患者阻滞起效时间,阻滞维持时间,术后镇痛、镇静效果,夜间睡眠,不良反应发生以及术中出血情况。结果B、D组阻滞维持时间分别较A、C组明显延长(P<0.05),但术中出血明显增加;C组阻滞维持时间较A组明显延长(P<0.05),且术中出血情况无明显差异。A、B两组分别较术前在4 h、8h后VAS评分明显升高,Ramsay评分显著降低(P<0.05),A组夜间睡眠较差且需要辅助用药,B组夜间睡眠好;C组较术前在12 h后VAS评分明显升高(P<0.05),但Ramsay评分无明显变化(P>0.05),夜间睡眠可;D组较术前在48 h内VAS评分和Ramsay评分均无明显变化(P>0.05),夜间睡眠好。结论小剂量右美托咪啶辅助神经阻滞可延长局麻药物作用时间,提供良好的睡眠.但无明显的止血作用。罗哌卡因和肾上腺素配伍,能获得更长的阻滞维持时间,明显减少术中出血从而提高患者的舒适度和满意度。Objective To observe the nerve block effect and intraoperative bleeding of different local anesthetics used in patients with carpal tunnel syndrome(CTS).Methods Sixty patients with CTS were randomly divided into 4 groups with 15 patients in each,namely lidocaine+adrenaline group(group A),lidocaine+dexmedetomidine group(group B),ropivacaine+adrenaline group(group C),ropivacaine+dexmedetomidine group(group D).The onset time,maintenance time,analgesic and sedative effects,night sleep,adverse reactions and intraoperative bleeding were observed.Results The duration of block in group B and D was significantly longer than that in group A and C(P<0.05),but the intraoperative bleeding was significantly increased.The duration of block in group C was significantly longer than that in group A(P<0.05),and there was no significant difference in intraoperative bleeding.The VAS scores of group A and B 4 or 8 hours after operation were significantly higher and Ramsay scores were significantly lower than those before operation(P<0.05).The night sleep of group A was worse and needed adjuvant medication,while that of group B was bette The VAS score of group C 12 hours after operation was significantly higher than that before operation(P<0.05),but Ramsay score had no significant change(P>0.05).The night sleep of group C was acceptable.The VAS score and Ramsay score of group D had no significant change within 48 hours after operation(P>0.05)and the night sleep was good.Conclusion Low dose dexmedetomidine-assisted nerve block can prolong the action time of local anesthetics and provide a good night sleep,but it has no obvious hemostatic efficacy.The combination of ropivacaine and epinephrine can achieve blockade duration,sigificantly decrease the intraoperative blood loss,which will improve patients'comfort and satisfaction.

关 键 词：腕管综合征 麻醉药 神经阻滞效果 

分 类 号：R61[医药卫生—外科学]