不同阿片类药物复合局麻药用于肌间沟臂丛神经阻滞的效果研究  

Effect of different opioids combined with local anesthetics on intermuscular groove brachial plexus block

作　　者：丁蕊 DING Rui(Anesthesia Department,Kangmei Hospital,Purring 515300,China)

机构地区：[1]康美医院麻醉科,515300

出　　处：《中国实用医药》2020年第16期17-19,共3页China Practical Medicine

摘　　要：目的观察不同阿片类药物复合局麻药应用于肌间沟臂丛神经阻滞的镇痛效果。方法80例行臂丛神经阻滞的患者,随机分为A组、B组、C组、D组,每组20例。A组用药为0.375%罗哌卡因20 ml,B组为0.375%罗哌卡因20 ml+2μg/kg芬太尼,C组为0.375%罗哌卡因20 ml+0.2μ/kg舒芬太尼,D组为0.375%罗哌卡因20 ml+120μg/kg地佐辛。比较四组患者术中血压[收缩压(SBP)、舒张压(DBP)]、心率(HR)、血氧饱和度(SpO2)水平;感觉和运动神经阻滞起效时间、镇痛持续时间;麻醉后4、8、12 h的疼痛视觉模拟评分法(VAS)评分及不良反应发生情况。结果四组患者术中SBP、DBP、HR、SpO2水平比较,差异均无统计学意义(P>0.05)。B组和C组感觉及运动神经阻滞起效时间均明显短于A组和D组,差异均具有统计学意义(P<0.05);B组和C组镇痛持续时间分别为(6.8±0.5)、(7.1±0.7)h,均明显长于A组的(4.5±0.7)h和D组的(4.4±0.9)h,差异具有统计学意义(P<0.05)。B组和C组麻醉后4、8、12 h的疼痛VAS评分均明显优于A组和D组,差异均有统计学意义(P<0.05)。四组均未见不良反应。结论罗哌卡因复合小剂量芬太尼、舒芬太尼用于臂丛神经阻滞具有明显缩短感觉和运动神经起效时间、延长镇痛持续时间、改善麻醉效果、不良反应少等优点,值得临床推广,而地佐辛无此作用。Objective To observe the anesthesia effect of opioids combined with local anesthetics on intermuscular groove brachial plexus block.Methods A total of 80 groove brachial plexus block patients were randomly divided into group A,group B,group C and group D,with 20 cases in each group.Group A received 0.375%ropivacaine 20 ml,group B received 0.375%ropivacaine 20 ml and 2μg/kg fentanyl,group C received 0.375%ropivacaine 20 ml and 0.2μ/kg sufentanil,and group D received 0.375%ropivacaine 20 ml and 120μg/kg dezocine.The blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)],heart rate(HR),blood oxygen saturation(SpO2)]during surgery,onset time of sensory and motor nerve block,duration of analgesia,visual analogue scale(VAS)score 4,8 and 12 h after anesthesia and occurrence of adverse reactions were compared among the four groups.Results There was no statistically significant difference in levels of SBP,DBP,HR,SpO2 among the four groups(P>0.05).The onset time of sensory and motor nerve block of group B and group C were obviously shorter than those of group A and group D,and the difference was statistically significant(P<0.05).The duration of analgesia of group B and group C were(6.8±0.5)and(7.1±0.7)h respectively,which were obviously longer than that of group A(4.5±0.7)h and group D(4.4±0.9)h,and the difference was statistically significant(P<0.05).4,8 and 12 h after anesthesia,VAS score of group B and group C were obviously lower than those of group A and group D,and the difference was statistically significant(P<0.05).There were no obvious adverse reactions in the four groups.Conclusion Ropivacaine combined with low-dose fentanyl and sufentanil for brachial plexus block has the advantages of shortening the time of sensory and motor nerves,prolonging the duration of analgesia,improving the anesthetic effect with less adverse reactions.It is worthy of clinical promotion.Dizoxin has no such effect.

关 键 词：阿片受体 臂丛神经阻滞 镇痛效果 上肢手术 

分 类 号：R614[医药卫生—麻醉学]