超声引导下罗哌卡因联合右美托咪定和地塞米松IBPB在关节镜下肩部手术中的应用研究  

Application of ultrasound-guided ropivacaine combined with dexmedetomidine and dexamethasone IBPB in arthroscopic shoulder surgery

作　　者：李永健[1] 和建杰 李玉兰[2] Yong-jianLi;Jian-jie He;Yu-lanLi(Department ofAnesthesiology,The FirstPeople'sHospitalofBaiyinCity,Baiyin,Gansu 730900,China;Department ofAnesthesiology,The FirstHospitalofLanzhouUniversity,Lanzhou,Gansu 730000,China)

机构地区：[1]白银市第一人民医院麻醉科,甘肃白银730900 [2]兰州大学第一医院麻醉科,甘肃兰州730000

出　　处：《中国现代医学杂志》2021年第17期41-45,共5页China Journal of Modern Medicine

基　　金：甘肃省自然科学基金(No:17JR5RA262)。

摘　　要：目的探讨超声引导下罗哌卡因联合右美托咪定和地塞米松斜角肌间隙臂神经丛阻滞(IBPB)在关节镜下肩部手术中的应用价值。方法选取白银市第一人民医院102例拟行超声引导下IBPB关节镜下肩部手术患者,按照随机数字表法分为A、B、C 3组,每组34例。A组采用0.375%罗哌卡因30 ml阻滞,B组采用0.375%罗哌卡因+1.0μg/kg右美托咪定30 ml阻滞,C组采用0.375%罗哌卡因+1.0μg/kg右美托咪定+10 mg地塞米松30 ml阻滞。比较3组感觉阻滞、运动阻滞效果,以及疼痛视觉模拟评分(VAS)和并发症。结果3组感觉阻滞起效时间、感觉阻滞完善时间、运动阻滞起效时间、运动阻滞持续时间比较,C组短于B组和A组(P<0.05),B组短于A组(P<0.05);3组感觉阻滞评分比较,C组低于B组和A组(P<0.05),B组低于A组(P<0.05)。3组术后3 h、6 h VAS评分比较,C组低于B组和A组(P<0.05),B组低于A组(P<0.05);3组追加舒芬太尼比例比较,C组低于B组和A组(P<0.05),B组低于A组(P<0.05);C组并发症发生率低于B组和A组(P<0.05)。结论超声引导下右美托咪定和地塞米松可提高罗哌卡因IBPB效果,不良反应少。Objective To investigate the value of ropivacaine combined with dexmedetomidine and dexamethasone of ultrasound-guided interscalene brachial plexus block(IBPB)in arthroscopic shoulder surgery.Methods Totally 102 patients who planned to undergo arthroscopic shoulder surgery by ultrasound-guided IBPB were selected and divided into 3 groups by random number table method.Group A(34 cases)was treated with 30 ml 0.375%ropivacaine,group B(34 cases)was treated with 30 ml 0.375%ropivacaine and 1.0μg/kg dexmedetomidine,group C(34 cases)was treated with 30 ml 0.375%ropivacaine and 1.0μg/kg dexmedetomidine and 10 mg/kg dexamethasone.Compared the effect of sensory block,motion block,pain visual analog scale(VAS)score and complications between 3 groups.Results The onset time of sensory block,completion time of sensory block,onset time of motor block,and duration of motor block in group C were shorter than those in group B and A(P<0.05),and group B was shorter than that in group A(P<0.05).The sensory block score of group C was lower than that of group B and A(P<0.05),and group B was lower than that of group A(P<0.05).Pain VAS scores at postoperative 3 h,6 h in group C was higher than that in group B and A(P<0.05),and group B was lower than that of group A(P<0.05).The proportion of sufentanil in group C was lower than that in group B and A(P<0.05),and group B was lower than that in group A(P<0.05).The complication rate of group C was lower than that of group B and A(P<0.05).Conclusion Ropivacaine combined with dexmedetomidine and dexamethasone of ultrasound guided space brachial plexus nerve block can enhance the analgesic effect and have low adverse reactions.

关 键 词：关节镜手术 斜角肌间隙臂神经丛阻滞 罗哌卡因 右美托咪定 地塞米松 斜角肌 关节镜 

分 类 号：R614[医药卫生—麻醉学]