摘要
目的:探讨不同容量罗哌卡因在超声引导下肌间沟臂丛神经阻滞的应用效果,为超声引导下肌间沟臂丛神经阻滞中罗哌卡因容量选择提供参考。方法:选取2016年6月~2019年10月本院拟行上肢骨折手术患者80例为研究对象,采用随机数字表法分为A组(n=40)和B组(n=40),其中A组采用0.375%罗哌卡因30 ml,B组采用0.375%罗哌卡因20 ml。注射药物20 min后评价尺神经、正中神经、前臂内侧皮神经等神经分布区的麻醉效果。统计比较神经完全阻滞效果、神经阻滞起效时间、镇痛持续时间、运动阻滞恢复时间以及不良反应和并发症发生率等。神经阻滞前、注射药物后30 min对两组膈肌活动度进行测量比较。结果:A组患者尺神经、正中神经、前臂内侧皮神经阻滞完善率均高于B组,具有统计学差异(P <0.05);A组尺神经、正中神经、前臂内侧皮神经阻滞起效时间短于B组,且A组镇痛持续时间和运动阻滞恢复时间长于B组(P <0.05);平静呼吸和用力呼吸状态下,两组阻滞后30 min膈肌活动度均低于阻滞前(P <0.05);A组阻滞后30 min膈肌部分及完全麻痹率高于B组,但两组比较无统计学差异(P> 0.05);两组气胸、喉返神经阻滞、上肢感觉及运动异常、声音嘶哑、恶心呕吐等不良反应和并发症发生率比较,无统计学差异(P>0.05)。结论:不同容量罗哌卡因在超声引导下肌间沟臂丛神经阻滞应用均安全有效,其中较高容量罗哌卡因在超声引导下肌间沟臂丛神经阻滞的起效时间缩短,且阻滞持续时间延长。
Objective:To explore the application effect of different volumes of ropivacaine in the ultrasound-guided intermuscular groove brachial plexus block,and to provide reference for the selection of volumes of ropivacaine in ultrasound-guided intermuscular groove brachial plexus block.Methods:From June 2016 to October 2019,80 patients with upper limb fracture scheduled with surgery in our hospital were selected as the study objects.The patients were randomly divided into group A(n=40)and group B(n=40)according to random number methods.In group A,30 ml of 0.375%ropivacaine was used,and 20 ml of 0.375%ropivacaine ropivacaine was used in group B.20 minutes after injection,the anesthesia effects of the nerve distribution areas such as ulnar nerve,median nerve and medial forearm cutaneous nerve in the 2 groups were evaluated.The effects of complete nerve block,onset time of nerve block,duration of analgesia,recovery time of nerve block,and rate of adverse reactions and complications in the 2 groups were compared.Before nerve block and 30 minutes after injection,diaphragmatic activity in the two groups was measured and compared.Results:The complete block rate of ulnar nerve,median nerve and medial forearm cutaneous nerve in group A was significantly higher than those in group B(P<0.05).The nerve block onset time of ulnar nerve,median nerve and medial forearm cutaneous nerve in group A were shorter than those in group B.And the duration of analgesia and recovery time of motor retardation in group A were longer than those in group B(P<0.05).In the state of calm breathing and forced breathing,diaphragmatic activity of the two groups at 30 minutes after injection were lower than those of before block(P<0.05).The 30 minutes after injection activity of diaphragm in group A was lower than that in group B,but without significant difference between the two groups(P>0.05).There was no significant difference in the rate of adverse reactions and complications between the two groups,such as pneumothorax,recurrent laryngeal nerve block,upper limb sensation and activity abnormality,hoarse voice,sick and vomiting(P>0.05).Conclusion:Different volumes of ropivacaine are safe and effective in the application of intermuscular groove brachial plexus block under the guidance of ultrasound.The onset time of higher volumes of ropivacaine is shorter and the duration of block is longer under the guidance of ultrasound.
作者
钱刚
闫宏
贺伟忠
高学超
闫国中
QIAN Gang;YAN Hong;HE Wei-zhong;GAO Xue-chao;YAN Guo-zhong(Department of Anesthesiology,Kaifeng Central Hospital,Kaifeng 475000,China)
出处
《中国合理用药探索》
CAS
2021年第2期76-80,共5页
Chinese Journal of Rational Drug Use
基金
国家自然科学基金资助项目(U1304807)。
关键词
容量
罗哌卡因
超声引导
肌间沟臂丛神经阻滞
应用效果
volumes
ropivacaine
ultrasound-guided
intermuscular groove brachial plexus block
application effect
