超声引导下不同浓度罗哌卡因臂丛神经阻滞心脏毒性的比较被引量：27

Comparison of cardiotoxicity between different concentrations of ropivacaine for brachial plexus block under the guidance of ultrasound

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摘要目的比较超声引导下不同浓度罗哌卡因对臂丛神经阻滞时的心脏毒性。方法选择择期行前臂或手部手术的病人60例,美国麻醉医师协会(ASA)Ⅰ-Ⅱ级,将以上病人随机分为三组(低浓度组为0.33%罗哌卡因组、中浓度组为0.4%罗哌卡因组、高浓度组为0.5%罗哌卡因组),每组20例。在超声引导下行腋路臂丛神经阻滞,记录每组患者麻醉起效时间、镇痛维持时间、阻滞效果、功能恢复时间及不良反应的发生率。并分别于注药前(T_0)和注药后24 h(T_1)抽取肘静脉血4 ml,测定血清cTnI、CKMB。结果随着罗哌卡因浓度的增加,麻醉起效时间逐渐缩短、镇痛维持时间和功能恢复时间逐渐延长,阻滞效果无差异,三组病人均无不良反应发生。三组患者注药后24 h cTnI、CKMB均较注药前有所增高,三组间相比,随着罗哌卡因浓度的增加,注药后24 h血清cTnI、CKMB含量也依次增大,差异有统计学意义(P<0.05)。结论超声引导下行腋路臂丛神经阻滞时,0.33%、0.4%、0.5%罗哌卡因均可满足手术需求。随罗哌卡因浓度的增加,心脏毒性增加,从起效时间、镇痛维持时间、功能恢复时间、心脏毒性综合考虑,超声引导下行腋路臂丛神经阻滞时推荐给予0.4%罗哌卡因。 Objective To compare the cardiotoxicity between different concentrations of ropivacaine applied to brachial plexus block under the guidance of ultrasound.Methods Sixty patients with ASAⅠ- Ⅱundergoing elective forearm or hand surgery were randomly divided into three groups：0.33% ropivacaine group,0.40% ropivacaine group,0.50% ropivacaine group.Axillary brachial plexus was blocked under the guidance of ultrasound,the onset time of analgesia,duration of analgesia,block effect,function recovery time and incidence of adverse reactions were recorded.Four milliliters blood samples were taken from veins of the patients for determining the serum cTnI and CK-MB before anesthesia and 24 h after drug injection.Results With the increase of concentration of ropivacaine,the onset time became shorter,and the duration of analgesia and function recovery time became longer.The effects of brachial plexus block showed no statistically significant difference between the groups.No adverse reaction occurred in three goups.The cTnI,CK-MB levels increased at 24 h after drug injection.The cTnI,CK-MB levels increased with the increase of concentration of ropivacaine,and there was significant difference between the groups（ P0.05）.Conclusion The 0.33%- 0.50% ropivacaine can meet the requirement of axillary brachial plexus block under the guidance of ultrasound,but the cardiotoxicity may increase in a concentration-dependent manner.Considering onset time of analgesia,duration of analgesia,function recovery time and cardiotoxicity,0.4%ropivacaine may be recommended for ultrasound-guided brachial plexus block.

作者陈慧清高东艳任伟侠

机构地区山西医科大学麻醉学系麻醉科山西医科大学第二医院麻醉科

出处《山西医科大学学报》 CAS 2017年第1期65-68,共4页 Journal of Shanxi Medical University

关键词罗哌卡因超声引导臂丛神经阻滞心脏毒性 ropivacaine ultrasound guide brachial plexus block cardiotoxicity

分类号 R614 [医药卫生—麻醉学]