超声引导下甲哌卡因与罗哌卡因联用对断指再植患者神经阻滞的效果  

ANESTHETIC EFFECT OF ULTRASOUND-GUIDED AXILLARY BRACHIAL PLEXUS BLOCK WITH MEPIVACAINE AND ROPIVACAINE IN PATIENTS UNDERGOING SEVERED FINGER REPLANTATION

作　　者：王德明 姜英俊[2] 曲彦亮 费圣强 温宝磊 储艳 WANG Deming;JIANG Yingjun;QU Yan-liang;FEI Shengqiang;WEN Baolei;CHU Yan(Hand Surgery Center of the 971st Hospital of the Navy,Qingdao 266071,China)

机构地区：[1]海军第971医院全军手外科中心麻醉科,山东青岛266071 [2]青岛大学附属医院平度院区普外科

出　　处：《精准医学杂志》2021年第3期195-198,共4页Journal of Precision Medicine

基　　金：山东省医药卫生科技发展计划项目(2016WS0726)。

摘　　要：目的评价10.00 g/L甲哌卡因与不同浓度罗哌卡因联合用于断指再植患者腋路臂丛神经阻滞的效果。方法选择按照美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级急诊断指再植者90例,采用随机数字表法将患者分为A、B、C 3组,每组30例。各组在超声联合神经刺激器定位下行腋路臂丛神经阻滞。A组局麻药采用10.00 g/L甲哌卡因+3.75 g/L罗哌卡因,B组采用10.00 g/L甲哌卡因+1.25 g/L罗哌卡因,C组采用3.75 g/L罗哌卡因。正中神经、尺神经和桡神经每根神经使用10 mL局麻药进行阻滞,肌皮神经使用5 mL局麻药进行阻滞;若两根目标神经包绕在一起则注射20 mL局部麻醉药进行阻滞。分别记录3组患者的感觉、运动神经阻滞起效与恢复时间及不良反应等。结果 3组患者感觉、运动神经阻滞起效时间比较差异有显著性(F=5.65、4.16,P<0.05),A、B组感觉、运动神经阻滞起效时间与C组比较明显缩短(q=2.90~4.41,P<0.05)。3组患者感觉、运动神经阻滞恢复时间比较差异有显著性(F=10.01、15.07,P<0.05);B组患者感觉、运动神经阻滞恢复时间与A、C组比较明显缩短(q=5.29~6.86,P<0.05)。A、C组患者麻醉效果优于B组(Hc=12.89,P<0.05)。结论超声辅助神经刺激器引导下,将10.00 g/L甲哌卡因联合3.75 g/L罗哌卡因臂丛神经阻滞能够明显缩短感觉、运动神经阻滞起效时间,且阻滞维持时间较长,适合断指再植手术。Objective To investigate the anesthetic effect of axillary brachial plexus block with 10.00 g/L mepivacaine and different concentrations of ropivacaine in patients undergoing severed finger replantation.Methods A total of 90 patients undergoing American Society of Anesthesiologists gradeⅠ-Ⅱemergency severed finger replantation were enrolled and divided into groups A,B,and C using a random number table,with 30 patients in each group.Axillary brachial plexus block was performed for each group under the guidance of ultrasound and nerve stimulator localization.The patients in group A were given local anesthesia with 10.00 g/L mepivacaine+3.75 g/L ropivacaine,those in group B were given 10.00 g/L mepivacaine+1.25 g/L ropivacaine,and those in group C were given 3.75 g/L ropivacaine.The median nerve,the ulnar nerve,and the radial nerve were blocked with 10 mL of local anesthetic,and the musculocutaneous nerve was blocked with 5 mL of local anesthetic;if the two target nerves were wrapped together,20 mL of local anesthetic was injected.The onset and recovery time of sensory and motor nerve block and adverse reactions were recorded for each group.Results There were significant differences in the onset time of sensory and motor nerve block between the three groups(F=5.65,4.16,P<0.05),and compared with group C,groups A and B had significantly shorter onset time of sensory and motor nerve block(q=2.90-4.41,P<0.05).There were significant differences in the recovery time of sensory and motor nerve block between the three groups(F=10.01,15.07,P<0.05),and compared with groups A and C,group B had significantly shorter recovery time of sensory and motor nerve block(q=5.29-6.86,P<0.05).Groups A and C showed a better anesthetic effect than group B(Hc=12.89,P<0.05).Conclusion Under the guidance of ultrasound and nerve stimulator,brachial plexus nerve block with 10.00 g/L mepivacaine+3.75 g/L ropivacaine can significantly shorten the onset time of sensory and motor nerve block and maintain the block for a long time,which is suitab

关 键 词：甲哌卡因 罗哌卡因 神经传导阻滞 臂丛 再植术 指 超声辅助 经皮神经电刺激 

分 类 号：R614[医药卫生—麻醉学] R658[医药卫生—外科学]