超声和神经刺激仪引导下罗哌卡因臂丛阻滞的感觉-运动分离作用研究  

Study on Sensory-Motor Separation Effect of Ropivacaine Brachial Plexus Block Under the Guidance of Ultrasound and Nerve Stimulator

作　　者：胡顺晴 王晖玥 张元信 刘中杰[3] 张新建 HU Shunqing;WANG Huiyue;ZHANG Yuanxin;LIU Zhongjie;ZHANG Xinjian(Dept. of Anesthesiology, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Guangzhou 510378, China;Dept. of Anesthesiology, Army Hand Surgery Center, Navy 971th Hospital, CPLA, Shandong Qingdao 266071, China;Dept. of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangdong Guangzhou 510282, China)

机构地区：[1]广州中医药大学第三附属医院麻醉科,广东广州510378 [2]中国人民解放军海军第971医院全军手外科中心麻醉科,山东青岛266071 [3]南方医科大学附属珠江医院麻醉科,广东广州510282

出　　处：《中国医院用药评价与分析》2020年第8期906-909,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：国家自然科学基金资助(No.81974187);广东省科技计划项目资助(No.2017ZC0145)。

摘　　要：目的:研究超声和神经刺激仪联合引导下盐酸罗哌卡因注射液锁骨上臂丛神经阻滞感觉-运动分离效果与其药物浓度的关系,并探讨延长感觉-运动分离作用效果的可行性。方法:将280例腕部以上神经、肌肉和关节功能正常的手外伤患者按随机数字表法分为十组(R1—R5、RD1—RD5各五组),每组28例。所有患者均采用超声和神经刺激仪联合引导下锁骨上臂丛神经阻滞,R1—R5组患者采用盐酸罗哌卡因注射液,均为40 ml,给药浓度分别为0.20、0.25、0.30、0.35及0.40 mg/ml;RD1—RD5组患者在给予盐酸罗哌卡因注射液(给药浓度对应R1—R5组)的基础上加用地塞米松磷酸钠注射液5 mg。观察十组患者手术时间、运动和感觉的阻滞效果,筛选感觉-运动分离合适剂量。结果:十组患者手术时间比较,差异无统计学意义(P>0.05)。十组患者运动和感觉阻滞程度随给药浓度的升高而加深,起效时间随给药浓度的升高而缩短,维持时间延长,各组间比较,差异均有统计学意义(P<0.05);RD1—RD5组患者与同剂量R1—R5组比较,起效时间的差异均无统计学意义(P>0.05),维持时间明显延长,差异均有统计学意义(P<0.05);不同剂量组相同时间点对运动神经阻滞程度不同,差异有统计学意义(P<0.05);R1、RD1、R2及RD2组患者术中疼痛和追加麻醉药的发生率与其他组比较,差异均有统计学意义(P<0.05);R3、RD3组患者的镇痛效果好且保持良好的肌张力。结论:采用0.30 mg/ml的盐酸罗哌卡因注射液40 ml实施锁骨上臂丛神经阻滞感觉-运动分离效果好;加入5 mg地塞米松磷酸钠注射液不影响起效时间和阻滞程度,但可明显延长麻醉药的作用时间。OBJECTIVE:To study the relationship between the sensory-motor separation effect of ropivacaine brachial plexus block and the drug concentration of ropivacaine hydrochloride injection under the guidance of ultrasound and nerve stimulator,and explore the feasibility of prolonging the effect of sensory-motor separation.METHODS:Two hundred and eighty patients with normal upper limb nerve,muscle and joint function treated with hand surgery were divided into 10 groups(5 groups each of R1-R5 and RD1-RD5)via random number table,with 28 cases in each group.All patients were treated with ultrasound and nerve stimulator to guide clavicle superior clavicle block.Patients in the R1-R5 group received 40 ml of ropivacaine hydrochloride injection with concentrations of 0.20,0.25,0.30,0.35 and 0.40 mg/ml,respectively.Patients in the RD1-RD5 group were given ropivacaine hydrochloride injection(with corresponding dose to the R1-R5 group)combined with dexamethasone 5 mg.The effect of drugs on the block of motion and sensation was evaluated among 10 groups,and the appropriate dose of sensory-motor separation was screened.RESULTS:There was no significant difference in surgery time among 10 groups(P>0.05).The degree of motor and sensory block in 10 groups of patients deepened with increasing concentration,the onset time decreased,and the maintenance time was prolonged,with statistically significant differences(P<0.05).The onset time of the RD1-RD5 group was the same as that of the same dose R1-R5 group,with no statistically significant difference(P>0.05),and the maintenance time was prolonged,the difference was statistically significant(P<0.05).Different dose groups had different degrees of motor nerve block at same time points,with statistically significant differences(P<0.05).Compared with other groups,the incidence of intraoperative pain and additional anesthetics in the R1,RD1,R2 and RD2 group was statistically significant(P<0.05).Patients in the R3 and RD3 group had good analgesia effect and maintained good muscle tension.CONCLUSI

关 键 词：臂丛神经阻滞 运动与感觉分离 罗哌卡因 地塞米松 超声 

分 类 号：R971.2[医药卫生—药品]