罗哌卡因用于超声引导老年腹股沟疝患者髂腹下、髂腹股沟联合生殖股神经阻滞的EC50及EC95  

EC50 and EC95 of ropivacaine for ultrasound-guided llioinguinal,lliohypogastric and genitocrural nerve block in aged patients with inguinal hernia

作　　者：孙熠[1] 王海云[1] 华伟 赵茗姝 SUN Yi;WANG Hai-yun;HUA Wei;ZHAO Ming-shu(Department of Anesthesiology,the Third Central Clinical College of Tianjin Medical University,the Third Central Hospital of Tianjin,Tianjin 300170,China)

机构地区：[1]天津医科大学三中心临床学院、天津市第三中心医院麻醉科,300170

出　　处：《天津医药》2020年第7期654-656,I0002,共4页Tianjin Medical Journal

摘　　要：目的确定罗哌卡因用于超声引导下老年腹股沟疝患者髂腹下、髂腹股沟联合生殖股神经阻滞的半数有效浓度(EC50)及95%有效浓度(EC95)。方法择期行单侧腹股沟疝无张力修补术男性患者35例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,体质量指数19~27 kg/m2,年龄65~79岁。在超声引导下行髂腹下、髂腹股沟联合生殖股神经阻滞,定位成功后,每个穿刺点注射罗哌卡因10 mL。手术开始前采用针刺法评价神经支配区域感觉阻滞情况,将手术开始前目标神经皮肤分布区均无痛觉即视觉模拟评分(VAS)=0分作为阻滞有效的标准。罗哌卡因浓度按Dixon序贯法确定,初始浓度为0.3%,阻滞有效时,下一例患者采用低一级浓度,反之,采用高一级浓度,相邻浓度的比值为1∶1.1。采用Probit概率单位回归分析法计算EC50、EC95及其95%可信区间(CI)。结果35例患者中18例(51.4%)阻滞成功,罗哌卡因EC50为0.263%(95%CI:0.248%~0.280%),EC95为0.348%(95%CI:0.323%~0.371%)。结论超声引导下髂腹下、髂腹股沟联合生殖股神经阻滞用于老年腹股沟疝手术时罗哌卡因的EC50及EC95分别为0.263%及0.348%。Objective To determine the median effective concentration(EC50) and 95% effective concentration(EC95)of ropivacaine for ultrasound-guided llioinguinal,lliohypogastric and genitocruralnerve block in aged patients with inguinal hernia.Methods Thirty-five male patients,American Society of Anesthesiologists physical status Ⅱ or Ⅲ,body mass index 19-27 kg/m2,aged 65-79 yr,scheduled for elective unilateral tension-free inguinal hernia repair were included in this study.Patients received an ultrasound-guided llioinguinal,lliohypogastric,and genitocrural nerve block.After successful location 10 mL ropivacaine was injected at each puncture point.The sensory block of the areas innervated by the nerves were assessed by pin-prick test.The painless of the areas innervated by target nerves(VAS=0) at the beginning of operation was regarded as the effective block.The concentration of ropivacaine was determined by Dixon up-and-down method.The initial concentration was 0.3%.When the block was effective,the next patient was given the low first-order concentration,on the contrary,the patient was given the high first-order concentration.The ratio between the adjacent concentrations was 1:1.1.The EC50,EC95 and their 95% confidence interval(CI) were calculated by probit analysis.Results Eighteen(51.4%) in a total of 35 patients received a successful nerve block.The EC50 of ropivacaine was 0.263%(95%CI:0.248%-0.280%) and the EC95 was 0.348%(95%CI:0.323%-0.371%).Conclusion The EC50 and EC95 of ropivacaine for ultrasound-guided llioinguinal,lliohypogastric and genitocrural nerve block are 0.263% and 0.348% in aged patients with inguinal hernia respectively.

关 键 词：神经传导阻滞 疝 腹股沟 老年人 超声检查 剂量效应关系 药物 罗哌卡因 生殖股神经 

分 类 号：R614[医药卫生—麻醉学]