混合右美托咪定时0.5%罗哌卡因用于超声引导股神经阻滞的ED_(50):单位股神经横截面积剂量  

Median effective dose of 0.5%ropivacaine for ultrasound-guided femoral nerve block when combined with dexmedetomidine:dose based on per unit femoral nerve cross-sectional area

作　　者：黄洁[1] 余淑珍[2] 郭浩[2] Kenichi Ueda 张玮玮[2] 李志山[2] Huang Jie;Yu Shuzhen;Guo Hao;Kenichi Ueda;Zhang Weiwei;Li Zhishan(Department of Anesthesiology,Maternal and Child Hospital of Hunan Province,Changsha 410000,China;Department of Anesthesiology,People′s Hospital of Shanxi Province,Taiyuan 030012,China;Department of Anesthesiology,Kameda General Hospital,Chiba 296-8602,Japan)

机构地区：[1]湖南省妇幼保健院麻醉手术科,长沙410000 [2]山西省人民医院麻醉科,太原030012 [3]龟田综合医院麻醉科,日本千叶296-8602

出　　处：《中华麻醉学杂志》2021年第9期1116-1119,共4页Chinese Journal of Anesthesiology

摘　　要：目的确定混合右美托咪定时0.5%罗哌卡因用于超声引导股神经阻滞按股神经横截面积用药的ED_(50)。方法选择行髌骨骨折切开复位内固定术或髌骨骨折内固定取出术患者,ASA分级Ⅰ或Ⅱ级,BMI 20~30 kg/m^(2),年龄18~64岁,性别不限,采用随机数字表法分为右美托咪定+罗哌卡因组(DR组)和罗哌卡因组(R组)。DR组注射0.5%罗哌卡因+右美托咪定0.5μg/kg,R组注射0.5%罗哌卡因。超声引导下定位股神经,测量股神经横截面积,根据股神经横截面积注入0.5%罗哌卡因,采用Dixon序贯法进行试验,起始剂量为0.22 ml/mm^(2),相邻剂量差值为0.02 ml/mm^(2)。阻滞有效标准:神经阻滞30 min内膝关节前侧皮肤、小腿内侧面和足背内侧缘皮肤均无痛觉和Brunnstrom运动功能评定法为1~3期。若以上神经分布区有1处存在痛觉即认为神经阻滞无效。出现7个有效和无效交替波终止研究。采用Probit法计算ED_(50)及其95%可信区间(CI)。结果R组27例患者纳入研究,0.5%罗哌卡因股神经阻滞ED_(50)为0.106 ml/mm^(2),95%CI为0.069~0.125 ml/mm^(2)。DR组23例患者纳入研究,0.5%罗哌卡因股神经阻滞ED_(50)为0.038 ml/mm^(2),95%CI为0.011~0.059 ml/mm^(2)。与R组比较,DR组0.5%罗哌卡因股神经阻滞ED_(50)降低(P<0.05)。结论混合右美托咪定0.5μg/kg时,0.5%罗哌卡因用于超声引导股神经阻滞的按股神经横截面积用药ED_(50)为0.038 ml/mm^(2)。Objective To determine the median effective dose(ED_(50))of 0.5%ropivacaine when combined with dexmedetomidine based on femoral nerve cross-sectional area for ultrasound-guided femoral nerve block.Methods American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 18-64 yr,with body mass index of 20-30 kg/m^(2),scheduled for elective open reduction and internal fixation for patella fracture or removal of patella fracture by internal fixation,were randomly divided into dexmedetomidine and ropivacaine group(group DR)and ropivacaine group(group R).In group DR,0.5%ropivacaine and 0.5μg/kg dexmedetomidine were injected.In group R,0.5%ropivacaine was injected.Ultrasonic localization of femoral nerve was performed for measurement of the femoral nerve cross-sectional area,and 0.5%ropivacaine was injected based on the area.ED_(50)was determined by Dixon′s up-and-down sequential method.The initial dose was 0.22 ml/mm^(2),and the difference between the two successive doses was 0.02 ml/mm^(2).The effective block was defined as complete loss of pain sensation in the areas of anterior skin of knee joint,skin on the inner side of the calf and dorsal medial skin of the foot and the degree of motor block was in stages 1-3 assessed using Brunnstrom motor function within 30 min after nerve block.Nerve block was considered ineffective if pain occurred in any nerve distribution area mentioned above.The study was terminated if 7 effective and ineffective alternating waves occurred.ED_(50)and 95%confidence interval(CI)were calculated using Probit analysis.Results In group R,27 patients were enrolled in the study,and ED_(50)(95%CI)of 0.5%ropivacaine for ultrasound-guided femoral nerve block was 0.106(0.069-0.125)ml/mm^(2).In group DR,23 patients were enrolled in the study,and ED_(50)(95%CI)of 0.5%ropivacaine for ultrasound-guided femoral nerve block was 0.038(0.011-0.059)ml/mm^(2).Compared with group R,ED_(50)of 0.5%ropivacaine for femoral nerve block was significantly decreased in group R.Conclusion When

关 键 词：右美托咪啶 酰胺类 神经传导阻滞 剂量效应关系 药物 超声检查 

分 类 号：R614[医药卫生—麻醉学]