葡萄糖溶液稀释盐酸罗哌卡因对锁骨上臂丛神经阻滞的影响  

The block effect of ropivacaine hydrochloride diluted with glucosesolution on supraclavicular brachial plexus

作　　者：曹林 田蜜[3] 段满林[3] 陈静 刘国印 周斌 CAO Lin;TIAN Mi;DUAN Man-lin;CHEN Jing;LIU Guo-yin;ZHOU Bin(Department of Anesthesiology,Qinhuai District Medical Area of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Orthopedics,Qinhuai District Medical Area of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Anesthesiology,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院秦淮医疗区麻醉科,南京210002 [2]东部战区总医院秦淮医疗区骨科,南京210002 [3]东部战区总医院(原南京军区南京总医院)麻醉科,南京210002

出　　处：《医学研究生学报》2021年第5期490-495,共6页Journal of Medical Postgraduates

基　　金：江苏省自然科学基金(BK20181113)。

摘　　要：目的用等渗盐水稀释的局部麻醉药物含有较多Na+,而高浓度钠可影响药物起效。文中旨在观察等渗盐水和3种葡萄糖溶液分别稀释罗哌卡因对锁骨上臂丛神经阻滞的影响,为临床选择合理局部麻醉药物稀释液提供依据。方法选取2020年3月至9月东部战区总医院秦淮医疗区行上肢手术患者93例,年龄18~65岁,BMI 18~30 kg/m 2,ASAⅠ或Ⅱ级。采用随机数字表法将纳入的患者分为等渗盐水组、5%葡萄糖溶液组、25%葡萄糖溶液组和50%葡萄糖溶液组。所有患者均在超声引导下行锁骨上臂丛神经阻滞。主要观察4组患者感觉和运动阻滞的起效时间及持续时间;次要或同时记录阻滞成功率及阻滞前后血压心率的变化。术后随访是否出现神经并发症。结果50%葡萄糖溶液组运动阻滞起效时间(4.5±1.4)min,稍快于等渗盐水组(6.2±2.3)(P=0.035)、5%葡萄糖溶液组(6.1±1.7)(P=0.044)和25%葡萄糖溶液组(6.2±2.3)min(P=0.034)。等渗盐水组、5%葡萄糖溶液组、25%葡萄糖溶液组和50%葡萄糖溶液组感觉阻滞持续时间分别为(657.7±61.8)、(797.5±92.6)、(478.8±66.7)和(373.7±78.9)min,运动阻滞持续时间分别为(586.7±51.6)、(728.7±95.6)、(407.7±66.9)和(328.7±64.1)min,组间差异有统计学意义(P<0.01),其中5%葡萄糖溶液组感觉和运动阻滞持续时间最长,50%葡萄糖溶液组持续时间最短。4组臂丛各分支神经感觉阻滞起效时间比较差异无统计学意义(P>0.05);阻滞成功率、阻滞前后平均动脉压和心率差异无统计学意义(P>0.05)。术后7 d内随访,4组患者均无神经并发症。结论在一定条件下,5%葡萄糖溶液稀释罗哌卡因,既能同样快速起效和完美镇痛,又能维持术后较长时间镇痛,安全可行,值得推广。Objective Local anesthetics diluted with normal saline contain relatively higher level of Na+,and high concentration of sodium could affect the onset of local anesthetics.The study was carried out to observe the effect of ropivacaine diluted with normal saline or three concentrations of glucose solution on supraclavicular brachial plexus block,and to provide a basis for reasonable selection of a local anesthetic dilution for clinical usage.Methods From March 2020 to September 2020,93 patients undergoing upper limb surgery in the Qinhuai Medical District of the Eastern Theater General Hospital,with age ranged 18~65 years,BMI ranged 18~30 kg/m 2,with ASA ofⅠorⅡgrade,were divided to four groups according to randomized,double blind controlled methods:Normal saline group(n=23),5%Glucose solution group(n=23),25%Glucose solution group(n=24)and 50%Glucose solution group(n=23).All patients of the four groups were performed supraclavicular brachial plexus block under ultrasound guidance.The onset time as well as duration of sensory and motor block in the four groups were observed.the success rate of block,the changes of blood pressure and heart rate before and after block were recorded.Whether there were neurological complications in the postoperative were followed up.Results The onset time of motor block in 50%Glucose solution group is(4.5±1.4)min,which is slightly faster than that in normal saline group(6.2±2.3)(P=0.035),5%Glucose solution group(6.1±1.7)(P=0.044)and 25%Glucose solution group(6.2±2.3)min(P=0.034).The duration of sensory block in normal saline group,5%Glucose solution group,25%Glucose solution group and 50%Glucose group were(657.7±61.8),(797.5±92.6),(478.8±66.7)and(373.7±78.9)min,respectively.The duration of motor block was(586.7±51.6),(728.7±95.6),(407.7±66.9)and(328.7±64.1)min.The difference among the four groups was statistically significant(P<0.001).Patients in the 5%Glucose solution group showed the longest duration of sensory and motor block.Patients in the 50%Glucose solution group s

关 键 词：葡萄糖 起效时间 罗哌卡因 锁骨上臂丛神经阻滞 

分 类 号：R33[医药卫生—人体生理学]