相同浓度不同容量罗哌卡因在长期吸烟史患者肌间沟臂丛神经阻滞麻醉中的应用  

Application of different volumes of ropivacaine of the same concentration in the interscalene brachial plexus block anesthesia in patients with a long history of smoking

作　　者：黄浩铭 吴论[1] 郭能起[1] 朱小兵[1] 萧治恒 杨扬 HUANG Hao-ming;WU Lun;GUO Neng-qi(Department of Anesthesiology,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China)

机构地区：[1]中山市中医院麻醉科,528400

出　　处：《中国实用医药》2022年第22期131-134,共4页China Practical Medicine

基　　金：中山市医学科研项目(项目编号:2018A020087)。

摘　　要：目的分析相同浓度不同容量罗哌卡因在长期吸烟史患者肌间沟臂丛神经阻滞麻醉中的应用价值。方法80例有长期吸烟史的上肢手术患者,随机分为观察组及对照组,各40例。两组均行肌间沟臂丛神经阻滞麻醉。对照组在臂丛的后外侧缓慢贴近臂丛神经,回抽无血后注入0.375%罗哌卡因5 ml,后将退针调整,将针尖推进至臂丛的前上方贴近臂丛神经,回抽无血后注入0.375%罗哌卡因5 ml,共10 ml。观察组在臂丛的后外侧缓慢贴近臂丛神经,回抽无血后注入0.375%罗哌卡因10 ml,后将退针调整,将针尖推进至臂丛的前上方贴近臂丛神经,回抽无血后注入0.375%罗哌卡因10 ml,共20 ml。比较两组阻滞30 min后臂丛神经阻滞效果、膈肌麻痹发生率,两组术前(T0)、起效即时(T1)、麻醉后4 h(T2)、麻醉后8 h(T3)、麻醉后12 h(T4)血氧饱和度(SpO_(2))及肺功能指标[每分钟最大通气量(MVV)、第1秒用力呼气容积占预计值的百分比(FEV1%pred)、FEV1/用力肺活量(FVC)],肺部并发症发生率。结果阻滞30 min后,观察组正中神经、肌皮神经、桡神经、尺神经感觉阻滞有效率分别为100.00%、97.50%、92.50%、100.00%,高于对照组的85.00%、80.00%、75.00%、82.50%,差异具有统计学意义(P<0.05);两组臂内侧皮神经、腋神经、前臂内侧皮神经感觉阻滞有效率比较,差异无统计学意义(P>0.05)。观察组阻滞后膈肌麻痹发生率67.50%(27/40)与对照组的62.50%(25/40)比较,差异无统计学意义(P>0.05)。两组不同时刻的SpO_(2)比较,差异无统计学意义(P>0.05);与T0时比较,两组T1、T2、T3时的MVV、FEV1%pred、FEV1/FVC均降低,但观察组T1、T2、T3时MVV、FEV1%pred、FEV1/FVC高于对照组,差异具有统计学意义(P<0.05);两组T4时的SpO_(2)、MVV、FEV1%pred、FEV1/FVC比较,差异无统计学意义(P>0.05)。两组肺部并发症发生率比较,差异无统计学意义(P>0.05)。结论20 ml 0.375%罗哌卡因对长期吸烟患者肌间沟臂丛Objective To analyze the application value of different volumes of ropivacaine of the same concentration in the interscalene brachial plexus block anesthesia in patients with a long history of smoking.Methods A total of 80 patients with a long history of smoking who underwent upper extremity surgery were randomly divided into observation group and control group,with 40 cases in each group.Both groups underwent interscalene brachial plexus block anesthesia.In the control group,the brachial plexus was slowly approached on the posterolateral side of the brachial plexus,and 5 ml of 0.375%ropivacaine was injected after the blood was withdrawn;a total of 10 ml of 0.375%ropivacaine was injected after no blood was drawn back.In the observation group,the brachial plexus was slowly approached on the posterolateral side of the brachial plexus,and 5 ml of 0.375%ropivacaine was injected after the blood was withdrawn;a total of 20 ml of 0.375%ropivacaine was injected after no blood was drawn back.Both groups were compared in terms of effects of brachial plexus block and the incidence of diaphragmatic paralysis after 30 min of blockade,blood oxygen saturation(SpO_(2))and pulmonary function indicators[maximum voluntary ventilation(MVV),forced expiratory volume in the 1st second FEV1 as a percentage of the predicted value(FEV1%pred),FEV1/forced vital capacity(FVC)]before surgery(T0),immediate onset(T1),4 h post-anesthesia(T2),8 h post-anesthesia(T3),12 h post-anesthesia(T4),and incidence of pulmonary complications.Results After 30 min of blockade,the effective rates of sensory block of the median nerve,musculocutaneous nerve,radial nerve and ulnar nerve in the observation group were 100.00%,97.50%,92.50%and 100.00%,which were higher than 85.00%,80.00%,75.00%and 82.50%in the control group,and the differences were all statistically significant(P<0.05).There was no statistically significant difference in the effective rate of sensory block of the medial brachial cutaneous nerve,axillary nerve and medial forearm cutaneous nerve betwe

关 键 词：浓度 容量 罗哌卡因 长期吸烟 肌间沟臂丛神经阻滞 

分 类 号：R614[医药卫生—麻醉学]