阻滞区脊神经反射对判断和预防下肢肌肉运动障碍的意义

Significance of spinal nerve reflex in blocked region for adjustment and prevention of motor disorder of lower limb muscles

目的:探讨硬膜外镇痛时脊神经反射改变对判断运动神经阻滞的意义。方法:成年男性患者110例,随机分为11组,每组10例,术后双盲法硬膜外注入“止痛液”8～10mL:R1～R5组为1.0,1.5,2.0,2.5,3g/L罗哌卡因,B1～B5组为1.0,1.5,2.0,2.5,3g/L布比卡因,N组为盐水。注药前后记录:视觉模拟评分(VAS);阻滞区健侧运动神经反射变化指令运动变化。结果:全部110例硬膜外麻醉,术后注药后出现下列变化:①VAS评分:R1组(4.6±0.6)cm,R2组(3.1±0.7)cm,R3组(2.9±0.8)cm,R4组(2.3±0.7)cm,R5组(2.1±0.9)cm及B1组(5.1±1.1)cm,B2组(4.2±1.3)cm,B3组(3.3±1.2)cm,B4组(1.2±1.1)cm,B5组(0.5±0.4)cm与N组(9.1±0.6)cm比较,均P<0.001。②反射:R1～2及B1～2组与N组比较P>0.05,R3～R5及B3～B5组与N组比较P<0.05或<0.01。③运动:R1～3及B1～2组与N组比较P>0.05,R4～R5及B3～B5组与N组比较P<0.05或<0.01。全组指令运动负性肌力改变出现率为38.2%,对应脊神经反射减弱或消失改变出现率为49.1%。结论:低含量罗哌卡因或布比卡因用于腰段硬膜外止痛时,1.5g/L以上均出现不同指程度运动阻滞,阻滞区脊神经反射改变与运动阻滞同步出现并且更为敏感,可作为临床示警性指标。

AIM:To investigate the significance of variation of spinal nerve reflex for ad justing motor nerve block during epidural analgesia. METHODS:One hundred and ten male patients were randomized into 11 groups of 10 cases in each group.Based on double blind method,all the patients received epid ural injection of “analgesic”at a dose of 8-10 mL, and then 1.0,1.5,2.0,2.5 a nd 3 g/L ropivacaine and bupivacaine were injected into the patients in the R1- R2 groups and B1-B5 groups respectively.Normal saline was injected into the pat ients in group N.The scores of visual analogue scale(VAS),variation of reflex ac tivities in the health side of blocked region and motor changes were recorded an d observed before and after administration. RESULTS:The epidural anesthesia in 110 cases was satisfactory. After postopera tive administration,the changes appeared as follows:①In respect of VAS,group R1 [(4.6±0.6) cm],group R2[(3.1±0.7) cm],group R3[(2.9±0.8) cm],group R4[(3.3±0 .7) cm],group R5[(2.1±0.9) cm] and group B1[(5.1±1.1) cm], group B2[(4.2±1.3) cm], group B3[(3.3±1.2) cm], group B4[(1.2±1.1) cm], group B5[(0.5±0.4) cm] showed significant differences as compared with group N[(9.1±0.6)cm](P< 0.001); ②As the reflex activities, significant differences were found between group R1 -R2,B1-B2 and group N(P >0.05),and between group R3-R5,B3-B5 and group N(P< 0.05 or P< 0.01);③As the motion,group R1-R3 and B1-B2 showed no significant c hanges as compared with group N(P >0.05),but significant changes were found in g roup R4-R5 and B3-B5 as compared with group N(P< 0.05 or P< 0.01).The percenta ge of muscular motor blocked was 38.2%,while relative percentage of reflex vari ed was 49.1%in all patients. CONCLUSION:During lumbar epidural analgesia for adult, if using above 1.5 g/L ropivacaine or bupivacaine, various motor blocking will take place. It is more s ensitive that spinal nerve block and motor block take place together,which can b e used as a warning in clinic.