超声引导下罗哌卡因肌间沟臂丛神经阻滞对颈交感神经功能的影响  

Effect of ultrasound-guided ropivacaine intersalene brachial plexus block on cervical sympathetic nerve function

作　　者：章利川 王新强[1] 刘涛 ZHANG Lichuan;WANG Xinqiang;LIU Tao(Department of Anesthesiology,First People’s Hospital of Huzhou,Huzhou 313000,CHINA)

机构地区：[1]湖州市第一人民医院麻醉科,浙江313000

出　　处：《江苏医药》2023年第1期18-21,共4页Jiangsu Medical Journal

基　　金：湖州市科技局公益性技术研究项目(2018GYB41)。

摘　　要：目的观察超声引导下0.375%罗哌卡因肌间沟臂丛神经阻滞(ISBPB)对颈交感神经功能的影响。方法上肢骨折手术患者40例在麻醉下行超声引导下0.375%罗哌卡因20 mL ISBPB,记录阻滞前后心率变异性参数、神经支配区域皮肤温度、交感神经皮肤反应(SSR)潜伏期和波幅的变化。观察麻醉效果及并发症发生情况。结果40例患者均取得满意的阻滞效果。阻滞后,心率变异性的低频功率、连续24 h内正常RR间期的标准差和相邻RR间期差值>50 ms的百分比均较阻滞前降低(P<0.05)。阻滞后,前臂桡侧和尺侧神经支配区域皮肤温度升高,掌心、示指指腹及且小指指腹SSR潜伏期缩短且SSR波幅升高(P<0.05)。2例发生霍纳综合征且自行缓解。结论超声引导下0.375%罗哌卡因ISBPB可以取得满意的麻醉效果,但对颈交感神经功能产生一定的影响,与麻醉药物扩散至颈交感神经节有关。Objective To observe the effect of ultrasound-guided 0.375%ropivacaine intersalene brachial plexus block(ISBPB)on the cervical sympathetic nerve function.MethodsUltrasound-guided ISBPB with 0.375%ropivacaine 20 mL was performed in 40 patients operated upon for upper limb fracture under general anesthesia.The changes of heart rate variability(HRV),skin temperature in the innervated areas,andincubation period and wave amplitude of sympathetic skin reaction(SSR)were recorded before and after ISBPB.The ISBPB efficacy and complications were observed.Results ISBPB was satisfactory in all 40 patients.Compared with before,the HRV indicators including lower frequency,standard diviation of NN intervals and percentage difference between adjacent RR intervals more than 50 ms were decreased after ISBPB(P<0.05).Compared with before,skin temperatures in the areas of the forearm innervated by the radial and ulnar nerves were increased after ISBPB(P<0.05),and incubation periods of SSR in the palm,index finger and small finger were shortened and wave amplitudes of SSR were increased(P<0.05),of whom 2 cases with developed Horner syndrome and spontaneously resolved.Conclusion Ultrasound-guided ISBPB with 0.375%ropivacaine can achieve satisfactory anesthesia effect,but it has a certain influence on the cervical sympathetic nerve function,which is related to the spread of narcotics to the cervical sympathetic ganglia.

关 键 词：肌间沟臂丛神经阻滞 罗哌卡因 颈交感神经 超声 

分 类 号：R614[医药卫生—麻醉学]