摘要
目的探讨分析肩关节镜手术中臂丛不同浓度罗哌卡因复合喉罩全身麻醉的效果及安全性。方法选取2016年7月至2018年7月南通大学第二附属医院行超声引导下臂丛神经阻滞复合喉罩全身麻醉肩关节镜手术治疗的病人180例,采用随机数字表法分为3组,每组各60例,分别给予罗哌卡因20 mL,罗哌卡因浓度分别为低剂量组(0.15%),中剂量组(0.25%),高剂量组(0.375%)。记录麻醉阻滞后15 min、30 min臂丛各主要神经的痛觉阻滞效应、运动阻滞程度;记录麻醉维持时间和运动阻滞恢复时间;比较麻醉阻滞后30 min及麻醉后监测治疗室(PACU)30 min时膈肌麻痹程度及肺功能;记录不良反应发生情况。结果注药15 min后低、中、高剂量组肌皮神经阻滞例数分别为25例、37例、48例,桡神经阻滞例数分别为24例、36例、47例,正中神经阻滞例数分别为20例、32例、44例,尺神经阻滞例数分别为11例、22例、34例,低、中、高剂量组各神经痛觉完全阻滞例数依次递增;中、高剂量组神经完全阻滞例数显著高于低剂量组(P<0.05);高剂量组运动阻滞3级为32例显著多于低剂量组16例(P<0.05)。注药30 min,三组各神经痛觉完全阻滞例数差异无统计学意义(P>0.05)。中、高剂量组注药后持续镇痛时间分别为(9.8±1.6)h、(9.4±1.6)h显著高于低剂量组(7.0±1.3)h(P<0.05)。麻醉阻滞后30 min时,高剂量组出现27例膈肌部分麻痹,9例全身麻痹,显著高于中剂量组13例部分麻痹,2例全身麻痹及低剂量组11例部分麻痹,2例全身麻痹(P<0.05);PACU30 min时,高剂量组34例膈肌部分麻痹,11例全身麻痹显著高于中剂量组17例膈肌部分麻痹,3例全身麻痹及低剂量组15例膈肌部分麻痹,2例全身麻痹(P<0.05)。麻醉阻滞30 min时,高剂量组用力肺活量(FVC)和1 s用力呼气容积(FEV1)为(2 457.07±130.17)mL、(3 37.23±93.56)mL/s显著低于中剂量组(2 710.38±133.45)mL、(374.65±89.52)mL/s及低剂量组(2 770.41±133.67)mL、(383.67±91.27)mL/s;PACU30 min时,高剂量组用力肺活量(FVC)和1 s用力呼气容积(FEV1)为(2 258.37±129.38)mL、(332.15±89.62)mL/s显著低于中剂量组(2 522.17±130.92)mL、(373.56±90.12)mL/s及低剂量组(2 546.82±130.48)m L、(376.35±90.68)mL/s,肺功能下降程度高剂量组显著高于中、低剂量组(P<0.05)。三组病人均未出现典型的不良反应。结论肩关节术中臂丛0.25%浓度罗哌卡因20 mL复合喉罩全身麻醉起效快,麻醉效果好,对膈肌和肺功能影响小,安全有效,为该容量下的最佳浓度。
Objective To investigate the effect and safety of different concentrations of ropivacaine for brachial plexus block combined with laryngeal mask general anesthesia in shoulder arthroscopy.Method180 patients underwent ultrasound-guided brachial plexus block combined with laryngeal mask general anesthesia for shoulder arthroscopy were selected and divided into 3 groups using random number table method,60 patients in each group,all the groups were given 20 mL of ropivacaine.The concentration of ropivacaine was 0.15%in the low-dose group,0.25%in the middle-dose group,and 0.375%in the high-dose group.Recorded the pain block effect and the degree of motor block of the main nerves of the brachial plexus at 15 min and 30 min after anesthesia.Record anesthesia maintenance time and movement block recovery time.Compared the time of diaphragmatic paralysis and lung function at anesthesia delay 30 min and PACU 30 min.Record the occurrence of adverse reactions.ResultsAfter 15 minutes of injection,25,37,and 48 cases of musculocutaneous nerve block were found in the low,medium,and high dose groups respectively.Radial nerve block cases were 24,36,and 47 cases,respectively.The number of cases was 20 cases,32 cases,44 cases,and the number of ulnar nerve block cases was 11 cases,22 cases,34 cases,the number of complete neuropathic blockades in the low,medium and high dose groups increased in turn.The number of complete nerve block in the middle and high dose groups was significantly higher than that in the low dose group(P<0.05).The number of patients with high-dose group with motor block 3 was significantly more than that of low-dose group:32 cases were significantly more than 16 cases of low-dose group(P<0.05).After 30 minutes of injection,there was no statistically significant difference in the number of cases of complete neural block in each of the three groups(P>0.05).The duration of analgesia after injection in the middle and high dose groups was(9.8±1.6)h and(9.4±1.6)h,respectively,which was significantly higher than that in the low dose group(7.0±1.3)h(P<0.05).When the anesthesia was delayed for 30 minutes,27 cases of partial paralysis of the diaphragm and 9 cases of general paralysis occurred in the high-dose group,which was significantly higher than 13 cases of partial paralysis in the middle-dose group,2 cases of general paralysis and 2 cases of low-dose group(P<0.05).At30 minutes of PACU,34 patients with partial diaphragm palsy in the high-dose group,11 patients with systemic paralysis were significantly higher than those in the middle-dose group with 17 patients with partial diaphragm palsy,3 patients with general palsy and15 patients with low-dose group partial diaphragm palsy,and 2 patients with general palsy(P<0.05).When anesthesia was blocked for 30 minutes,FVC and FEV1 in the high-dose group were(2457.07±130.17)mL,(337.23±93.56)mL/s,which was significantly lower than that in the middle-dose group(2710.38±133.45)mL,(374.65±89.52)mL/s and Low-dose group(2770.41±133.67)mL,(383.67±91.27)mL/s;FVC and FEV1 in high-dose group were(2258.37±129.38)mL,(332.15±89.62)mL/s at 30 minutes of PACU,which was significantly lower(2522.17±130.92)mL,(373.56±90.12)mL/s and low-dose group(2546.82±130.48)m L,(376.35±90.68)mL/s,the degree of lung function decline in the high-dose group was significantly higher than that in the low-dose group(P<0.05).There were no typical adverse reactions in all three groups of patients.ConclusionIn the shoulder joint,the 0.25%concentration of ropivacaine in the brachial plexus 20 mL compound laryngeal mask has a quick onset of anesthesia,good anesthesia effect,little effect on the diaphragm and lung function,which is safe and effective,and the optimal concentration under this volume.
作者
缪娟娟
张常伟
范建波
姚晓平
MIU Juanjuan;ZHANG Changwei;FAN Jianbo;YAO Xiaoping(Department of Anesthesiology,The Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China;Department of Orthopedics,The Second Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)
出处
《安徽医药》
CAS
2020年第7期1415-1419,共5页
Anhui Medical and Pharmaceutical Journal
基金
国家自然科学基金(81501866)。
