摘要
目的探讨纳布啡辅助罗哌卡因对超声引导下锁骨上入路臂丛神经阻滞麻醉效果的影响。方法本研究最终纳入2019年6月—2020年6月行上肢骨折切开复位内固定术患者共计114例为研究对象,随机分为N_(20)组(纳布啡20 mg)、N_(10)组(纳布啡10 mg)和安慰剂组,每组38例。N_(20)组麻醉药物为100 mg罗哌卡因稀释至18 mL联合纳布啡2 mL(10 mg/mL);N_(10)组麻醉药物为100 mg罗哌卡因稀释至18 mL联合纳布啡2 mL(5 mg/mL);安慰剂组麻醉药物为100 mg罗哌卡因稀释至18 mL联合0.9%氯化钠注射液2 mL。比较3组患者神经阻滞前(T_(0))、神经阻滞后10 min(T_(1))、手术结束即刻(T_(2))的收缩压(SBP)、舒张压(DBP)、心率(HR)。评估3组患者T_(1)时感觉阻滞(SB)和运动阻滞(MB)情况,记录SB起效时间、MB起效时间、SB持续时间、MB持续时间。记录术中及术后24 h内头晕、恶心、呕吐、皮肤瘙痒等不良反应发生情况。结果T_(1)时点,N_(20)组、N_(10)组SBP、DBP均低于安慰剂组,且N_(20)组SBP低于N_(10)组,差异有统计学意义(P<0.05)。T_(2)时点,3组SBP、DBP差异无统计学意义(P>0.05)。3组各时点HR差异均无统计学意义(P>0.05)。3组SB评分和MB评分比较,差异均无统计学意义(P>0.05)。N_(20)组、N_(10)组患者SB起效时间、MB起效时间均短于安慰剂组患者,SB持续时间和MB持续时间均长于安慰剂组患者,差异均有统计学意义(P<0.05)。N_(20)组术中低血压、恶心、头晕发生率均高于安慰剂组,且头晕发生率高于N_(10)组,差异有统计学意义(P<0.05)。N_(10)组与安慰剂组术中低血压、恶心、头晕发生率比较,差异无统计学意义(P>0.05)。3组患者呕吐、皮肤瘙痒、呼吸抑制发生率比较,差异无统计学意义(P>0.05)。结论纳布啡10 mg作为辅助药物能够增强超声引导下锁骨上入路臂丛神经阻滞的麻醉效果,并且不增高不良反应发生率。
Objective To investigate the influence of nalbuphine assisted by ropivacaine on anesthetic effect of brachial plexus block via ultrasound-guided supraclavicular approach.Methods A total of 114 patients with open reduction and internal fixation for upper limb fractures from June 2019 to June 2020 were finally included as study objects,and they were randomly divided into N_(20) group(20 mg naborphine),N_(10) group(10 mg naborphine)and placebo group,with 38 cases in each group.The N_(20) group were given 100 mg ropivacaine diluted to 18 mL in combination with 2 mL naborphine(10 mg/mL);the N_(10) group were given 100 mg ropivacaine diluted to 18 mL in combination with 2 mL naborphine(5 mg/mL);the placebo group were given 100 mg ropivacaine diluted to 18 mL in combination with 2 mL 0.9%sodium chloride injection.The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the three groups were compared before nerve block(T_(0)),10 minutes after nerve block(T_(1)) and immediately after operation(T_(2)).The sensory block(SB)and motor block(MB)at T_(1) in the three groups were evaluated,and the onset time of SB,onset time of MB,duration of SB and duration of MB were recorded.Adverse reactions such as dizziness,nausea,vomiting and skin pruritus were recorded during and within 24 hours after operation.Results At T_(1),SBP and DBP in the N_(20) group and the N_(10) group were significantly lower than those in the placebo group,and SBP in the N_(20) group was significantly lower than that in the N_(10) group(P<0.05).At T_(2),there were no significant differences in SBP and DBP among the three groups(P>0.05).There was no significant difference in HR among the three groups at each time point(P>0.05).There were no significant differences in SB score and MB score among the three groups(P>0.05).The onset time of SB and MB in the N_(20) group and the N_(10) group were significantly shorter than those in the placebo group,and the duration of SB and MB were significantly longer than those in the placebo group(P<0.05).The incidence rates of intraoperative hypotension,nausea and dizziness in the N_(20) group were significantly higher than those in the placebo group,and the incidence rate of dizziness was significantly higher than that in the N_(10) group(P<0.05).There were no significant differences in the incidence rates of intraoperative hypotension,nausea and dizziness between the N_(10) group and the placebo group(P>0.05).There were no significant differences in the incidence rates of vomiting,skin pruritus and respiratory depression among the three groups(P>0.05).Conclusion As an adjuvant drug,10 mg naborphine can enhance the anesthetic effect of brachial plexus block via ultrasound-guided supraclavicular approach without increasing the incidence of adverse reactions.
作者
徐振华
高艳平
朱宏岩
XU Zhenhua;GAO Yanping;ZHU Hongyan(Department of Anesthesiology,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang,Jiangsu,215600)
出处
《实用临床医药杂志》
CAS
2022年第6期77-81,共5页
Journal of Clinical Medicine in Practice
基金
国家自然科学基金资助项目(81801109)。
关键词
纳布啡
罗哌卡因
锁骨上入路
臂丛神经阻滞
超声
感觉阻滞
运动阻滞
naborphine
ropivacaine
supraclavicular approach
brachial plexus block
ultrasound
sensory block
motor block
