M型超声评估罗哌卡因联合纳布啡行臂丛神经阻滞对膈肌移动度的影响  

Evaluation of Diaphragmatic Mobility after Brachial Plexus Block with Ropivacaine Combined with Nalbuphine by M-mode Ultrasound

作　　者：段巨澜 郑霜 王志江 曹婧芳 薛锐 张熙 胡培 DUAN Ju-lan;ZHENG Shuang;WANG Zhi-jiang;CAO Jing-fang;XUE Rui;ZHANG Xi;HU Pei(Department of Ultrasound,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China;Department of Anesthesiology,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]湖北医药学院附属人民医院超声影像中心,湖北十堰442000 [2]湖北医药学院附属人民医院麻醉科,湖北十堰442000

出　　处：《湖北医药学院学报》2023年第5期492-495,500,共5页Journal of Hubei University of Medicine

基　　金：湖北省卫生健康科研基金资助项目(WJ2019F046);十堰市科技局引导性科研项目(22Y60)。

摘　　要：目的:采用M型超声对比纳布啡与右美托咪定作为罗哌卡因麻醉佐剂在臂丛神经阻滞中的效果及对膈肌移动度的影响。方法:选取行右上肢臂丛神经阻滞患者70例,随机均分为NR组(罗哌卡因+纳布啡)与DR组(罗哌卡因+右美托咪定),利用M型超声分析阻滞前后膈肌移动度变化,并记录麻醉阻滞效果及麻醉并发症等情况。结果:NR组感觉及运动阻滞起效时间短于DR组、阻滞持续时间长于DR组,两组差异无统计学意义(P>0.05);用力呼吸下,DR组阻滞后30 min膈肌移动度明显低于阻滞前(P<0.05),且明显低于同期NR组(P<0.05);阻滞30 min时,平静呼吸或用力呼吸状态下,NR组膈肌总麻痹发生率均明显小于DR组(P<0.05)。两组不良反应中,DR组在阻滞后30 min内低血压及心动过缓的发生率高于NR组(P<0.05)。结论:纳布啡作为佐剂既可保证臂丛神经阻滞的麻醉效果,又可降低膈肌麻痹及其他不良反应的发生率。Objective To compare the effect of binalbuphine and dexmedetomidine as ropivacaine anesthesia adjuvant in brachial plexus block and its effect on diaphragmatic mobility by M-mode ultrasound.Methods 70 patients with right upper limb brachial plexus block were selected and randomly divided into NR group(ropivacaine+nabuprofen)and DR group(ropivacaine+dexmedetomidine).M-mode ultrasound was used to analyze the changes in diaphragm movement before and after block,and the anesthesia block effect and anesthesia complications were recorded.Results The onset time of sensory and motor block in the NR group was shorter than that in the DR group,and the block duration was longer than that in the DR group.There was no statistically significant difference between the two groups(P>0.05).Under forced breathing,the diaphragm movement in the DR group was significantly lower at 30 minutes after block than before block(P<0.05),and significantly lower than the NR group during the same period(P<0.05).When blocked for 30 minutes,the incidence of total diaphragmatic paralysis in the NR group was significantly lower than that in the DR group under calm or forced breathing conditions(P<0.05).Among the two groups of adverse reactions,the incidence of hypotension and bradycardia within 30 minutes after block in the DR group was higher than that in the NR group(P<0.05).Conclusion Nalbuphine as an adjuvant can not only ensure the anesthetic effect of brachial plexus block,but also reduce the incidence of diaphragmatic paralysis and other adverse reactions.

关 键 词：M型超声 罗哌卡因 纳布啡 膈肌麻痹 

分 类 号：R614[医药卫生—麻醉学]