罗哌卡因联合利多卡因对超声引导下腋路臂丛神经阻滞麻醉的临床效果观察
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摘要
目的探讨罗哌卡因联合利多卡因用于超声引导下腋路臂丛神经阻滞麻醉的临床效果。方法选取2016年8月至2017年8月在本院行超声引导下腋路臂丛神经阻滞麻醉的上肢手术患者90例,采用随机数字表法分为A、B、C三组,每组30例,分别采用0.125%罗哌卡因、0.25%罗哌卡因复合1%利多卡因、0.125%罗哌卡因复合1%利多卡因进行臂丛神经阻滞。记录开始手术后切皮前(T_0)、切皮后5分钟(T_1)、切皮后10分钟(T_2)、切皮后60分钟(T_3)、切皮后90分钟(T_4)时各组患者的平均动脉压(mean arterial pressure,MAP),并于术后2、6、8、12、24小时采用Ramsay镇静评分法和BCS(Bruggmann comfort scale)舒适度评分法对各组患者进行镇静和舒适度评分。结果在T_0、T_1时,C组的MAP明显高于A组和B组,且A组明显高于B组,差异均有显著性(P<0.01),而T_2、T_3、T_4时点三组MAP比较差异无显著性(P>0.05)。术后2、6、8、12、24小时A、B两组的Ramsay镇静评分差异无显著性(P>0.05),术后8、12、24小时C组的Ramsay镇静评分低于A组和B组(P<0.05),而术后2小时及6小时C组的Ramsay镇静评分与A、B组比较差异无显著性(P>0.05)。术后2、6、8、12、24小时B组的BCS舒适度评分均明显高于A组和C组,且A组明显高于C组,差异均有显著性(P<0.05)。结论 0.25%罗哌卡因复合1%利多卡因用于超声引导下腋路臂丛神经阻滞麻醉不仅可减轻术中血压波动,而且具有良好的术后镇静效果和舒适度,值得临床应用。
Objective To investigate the effect of lidocaine combined with ropivacaine on ultrasound-guided axillary brachial plexus block.Method Ninety patients who underwent upper limb surgery from August 2016 to August 2017 were enrolled in this study.Patients were divided into three groups:A,B and C by random number table.Three of which were ultrasound-guided axillary brachial plexus blockade medication.A group of 0.125%ropivacaine,group B with 0.25%ropivacaine complex 1%lidocaine,C group 0.125%ropivacaine compound lidocaine.The MAP of before operation(T_0),after 5 minutes operation(T_1),after 10 minutes operation(T_2),after 60 minutes operation(T_3),and after 90 minutes operation(T_4),were used to evaluate the sedation and comfort of the patients at 2h,6h,8h,12h and 24hours after operation using Ramsay sedation score and BCS comfort score.Result T_0,T_1 time MAP value of group C>group A>group B(P<0.05).There was no significant difference in MAP values between T_2,T_3 and T_4(P>0.05).There was no significant difference in Ramsay sedation score between the two groups(P>0.05)at 2h,6h,8h,12h and 24h after operation,and the sedation score of group C was lower than that of A and B at 8h,12h and 24.There was no significant difference between the two groups in the sedation score between group A and group B,and group B>group C(P<0.05).Conclusion 0.25%ropivacaine combined with 1%lidocaine administration of ultrasound guided axillary brachial plexus block can not only reduce the patient’s upper limb caused by blood pressure fluctuations,but also has a good postoperative sedation effect and comfort.
Objective To investigate the effect of lidocaine combined with ropivacaine on ultrasound-guided axillary brachial plexus block.Method Ninety patients who underwent upper limb surgery from August 2016 to August 2017 were enrolled in this study.Patients were divided into three groups:A,B and C by random number table.Three of which were ultrasound-guided axillary brachial plexus blockade medication.A group of 0.125%ropivacaine,group B with 0.25%ropivacaine complex 1%lidocaine,C group 0.125%ropivacaine compound lidocaine.The MAP of before operation(T_0),after 5 minutes operation(T_1),after 10 minutes operation(T_2),after 60 minutes operation(T_3),and after 90 minutes operation(T_4),were used to evaluate the sedation and comfort of the patients at 2h,6h,8h,12h and 24hours after operation using Ramsay sedation score and BCS comfort score.Result T_0,T_1 time MAP value of group C>group A>group B(P<0.05).There was no significant difference in MAP values between T_2,T_3 and T_4(P>0.05).There was no significant difference in Ramsay sedation score between the two groups(P>0.05)at 2h,6h,8h,12h and 24h after operation,and the sedation score of group C was lower than that of A and B at 8h,12h and 24.There was no significant difference between the two groups in the sedation score between group A and group B,and group B>group C(P<0.05).Conclusion 0.25%ropivacaine combined with 1%lidocaine administration of ultrasound guided axillary brachial plexus block can not only reduce the patient’s upper limb caused by blood pressure fluctuations,but also has a good postoperative sedation effect and comfort.
引文
[1]赵彩霞,靳会欣,张在旺,等.不同剂量利多卡因对罗哌卡因臂丛神经阻滞时半数有效浓度的影响[J].中华麻醉学杂志,2015,35(7):844-847.
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[16]王大伟,王保国,候燕.罗哌卡因复合芬太尼腰-硬联合和硬膜外阻滞产程潜伏期分娩镇痛的效果比较[J].中国医刊,2014,65(8):95-98.
[17]曹志方.罗哌卡因复合地佐辛对臂丛神经阻滞麻醉效果的影响[J].辽宁医学院学报,2015,10(4):86-88.
[18]伊军,林惠华,杨庆国.超声引导下连续胫神经阻滞时0.2%罗哌卡因半数有效背景量[J].临床麻醉学杂志,2015,31(8):753-755.
[19]佘勇军.利多卡因复合罗哌卡因及利多卡因在臂丛神经阻滞中的应用效果[J].临床合理用药杂志,2015,8(21):113-114.
[2]张益维,方向明,张凯,等.超声引导定位下锁骨上臂丛神经阻滞利多卡因复合罗哌卡因剂量探讨[J].上海医学,2015,38(2):106-109.
[3]李廷,叶雯霞,赖小英,等.地塞米松联合利多卡因预防腹腔化疗不良反应的疗效观察[J].健康研究,2015,38(4):389-390.
[4]杨广坤,彭德良,廖荣宗,等.超声引导下右美托咪定混合罗哌卡因FICB对DDH手术的镇痛效果[J].中国妇幼健康研究,2016,27(3):399-401.
[5]张小宝,冯继英,朱品,等.超声引导臂丛神经阻滞用于肥胖患者上肢手术的效果[J].重庆医学,2015,44(4):516-518.
[6]杨宜科,李永录.超声引导在腋路臂丛神经阻滞的应用[J].广西中医药大学学报,2013,16(1):23-24.
[7]刘丽,彭明清,王中林,等.瑞芬太尼复合丙泊酚对老年子宫切除手术患者免疫功能、血流动力学及应激反应的影响[J].中国老年学,2017,37(3):23-25.
[8]龚婷,钟文,余革,等.腹腔镜胆囊切除术不同麻醉方式选择的比较研究[J].齐齐哈尔医学院学报,2015,32(32):4852-4854.
[9]Mao Y,Zhao J,Gao Y.Right beauty holds the mi organism and propofol for elderly patients with hip fracture surgery ICU sedation effect of comparative study[J].Zhonghua Yi Xue Za Zhi,2015,95(19):1493-1495.
[10]Yang L,Sun DF,Wu Y,et al.Intranasal administration of butorphanol benefits old patients undergoing H-uvulopalatopharyngoplasty:a randomized trial[J].BMC Anesthesiol,2015,15(1):1-7.
[11]郑彬,佘守章.局麻药在麻醉和镇痛领域的研究新进展[J].广东医学,2016,37(12):1754-1756.
[12]卜祥梅,王波,王耀岐.超声引导下臂丛神经阻滞麻醉效果观察[J].山东医药,2015,55(3):103-104.
[13]贺轲渝,杨家福.超声引导神经阻滞的应用现状与进展[J].实用医院临床杂志,2016,13(1):150-152.
[14]Neal JM,Brull R,Horn JL,et al.The Second American Society of Regional Anesthesia and Pain Medicine evidence-based medicine assessment of ultrasound-guided regional anesthesia:executive summary[J].Reg Anesth Pain Med,2015,41(2):181.
[15]Iadaresta F,Crescenzi C,Amini A,et al.Application of graphitic sorbent for online microextraction of drugs in human plasma samples[J].J Chromatogr A,2016,18(1422):34-42.
[16]王大伟,王保国,候燕.罗哌卡因复合芬太尼腰-硬联合和硬膜外阻滞产程潜伏期分娩镇痛的效果比较[J].中国医刊,2014,65(8):95-98.
[17]曹志方.罗哌卡因复合地佐辛对臂丛神经阻滞麻醉效果的影响[J].辽宁医学院学报,2015,10(4):86-88.
[18]伊军,林惠华,杨庆国.超声引导下连续胫神经阻滞时0.2%罗哌卡因半数有效背景量[J].临床麻醉学杂志,2015,31(8):753-755.
[19]佘勇军.利多卡因复合罗哌卡因及利多卡因在臂丛神经阻滞中的应用效果[J].临床合理用药杂志,2015,8(21):113-114.