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      标题:超声引导下不同浓度罗哌卡因对老年患者臂丛神经的阻滞效果比较
      作者:陆剑锋,梁波,陈文策,梁志劲    (化州市人民医院麻醉科,广东 化州 525100)
      卷次: 2018年29卷19期
      【摘要】 目的 比较超声引导下不同浓度罗哌卡因对老年患者臂丛神经的阻滞效果。方法 选择 2017年1~12月化州市人民医院麻醉科老年上肢手术患者80例,以随机数表法将其分为三组,A组25例给予浓度为0.25%的罗哌卡因,B组27例给予浓度为0.375%的罗哌卡因,C组28例给予浓度为0.5%的罗哌卡因,比较三组患者各部位神经完全阻滞率、麻醉效果及并发症情况。结果 C组患者的尺神经、桡神经、正中神经、肌皮神经完全阻滞率分别为 42.9%、46.4%、39.3%、42.9%,均明显高于B组的 14.8%、18.5%、11.1%、11.1%与A组的 12.0%、16.0%、12.0%、16.0%,差异均有统计学意义(P<0.05),而B组患者的上述各项指标分别与A组比较,差异均无统计学意义(P>0.05);A组患者的麻醉起效时间为(0.81±0.16) h,明显长于B组的(0.72±0.21) h和C组的(0.44±0.19) h,A组患者镇痛持续时间、术后麻醉苏醒时间分别为(6.11±1.21) h、(5.01±2.12) h,明显短于B组的(7.67±1.01) h、(6.99±2.09) h与C组的(8.91±1.07) h、(8.78±1.43) h,差异均有统计学意义(P<0.05),同时B组麻醉起效时间明显长于C组,B组镇痛时间及术后麻醉苏醒时间明显短于C组,差异均具有统计学意义(P<0.05);三组患者的呼吸困难、局部麻醉药物中毒、血压异常等主要并发症发生率比较差异均无统计学意义(P>0.05)。结论 超声引导下应用不同浓度罗帕卡因对老年患者进行臂丛神经阻滞效果存在一定差异,随着药物浓度的增加,麻醉起效时间缩短,镇痛持续时间延长,恢复时间延长,而不良反应相当,临床选择时应根据患者实际情况选择合理罗哌卡因浓度。
      【关键词】 超声;罗哌卡因;臂丛神经;阻滞效果
      【中图分类号】 R614.4 【文献标识码】 A 【文章编号】 1003—6350(2018)19—2729—03
Comparison of the effects of ropivacaine at different concentrations on brachial plexus block in elderly patientsunder ultrasound guidance. LU Jian-feng, LIANG Bo, CHEN Wen-ce, LIANG Zhi-jin. Department of Anesthesiology,Huazhou People's Hospital, Huazhou 525100, Guangdong, CHINA
      【Abstract】 Objective To compare the effects of ropivacaine at different concentrations on brachial plexusblock in elderly patients under ultrasound guidance. Methods A total of 80 elderly patients with upper extremity surgeryduring January 2017 and December 2017 in the Department of Anesthesiology in Huazhou People's Hospital were selectedand randomly divided into three groups by random number table method. Group A (n=25) was given ropivacaine with aconcentration of 0.25%, group B (n=27) was given ropivacaine at a concentration of 0.375%, and group C (n=28) was giv-en ropivacaine with a concentration of 0.5%. Then the total nerve block rate, anesthetic effect and complications of thethree groups were compared. Results The complete block rate of ulnar nerve, radial nerve, median nerve and musculocu-taneous nerve in group C was 42.9%, 46.4%, 39.3%, 42.9%, respectively, significantly higher than 14.8%, 18.5%, 11.1%,11.1% in group B, and 12.0%,16.0%,12.0%,16.0% in group A (P<0.05). And there were no significant differences be-tween group B and group A for the above indicators (P>0.05). The onset time of anesthesia in group A was (0.81±0.16) h,significantly longer than (0.72±0.21) h in group B and (0.44±0.19) h in group C (P<0.05). The duration of analgesia andpostoperative recovery time of anesthesia in group A were (6.11±1.21) h and (5.01±2.12) h, respectively, significantlyshorter than (7.67±1.01) h, (6.99±2.09) h in group B and (8.91±1.07) h, (8.78±1.43) h in group C (P<0.05). The onset timeof anesthesia in group B was significantly longer than that in group C; and the analgesic time and postoperative anesthesiarecovery time in group B were significantly shorter than those in group C (P<0.05). There were no significant differencesin the incidence of major complications such as dyspnea, local anesthetic drug poisoning, and abnormal blood pressure inthe three groups (P>0.05). Conclusion There are differences in the effects of ropivacaine at different concentrations onbrachial plexus block in elderly patients under ultrasound guidance. As the concentration of the drug increases, the onsettime of anesthesia is shortened, the duration of analgesia is prolonged, the recovery time is prolonged, while the adverse re-action is equivalent. Therefore, the clinical selection should be based on the actual situation of patients to choose a reason-able concentration of ropivacaine.
      【Key words】 Ultrasound; Ropivacaine; Brachial plexus block; Block effect·论 著·doi:10.3969/j.issn.1003-6350.2018.19.018

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