臂丛动静分离阻滞麻醉用于战伤救治的可行性研究

Feasibility study on the application of brachial plexus block separation of sensation and motion in war- wound emergency

目的比较不同浓度罗哌卡因与布比卡因配伍罂粟碱和地塞米松行臂丛麻醉的效果,研究长效动静阻滞分离用于战伤长途转运的可行性。方法200例肌腱修复与功能重建手术患者,随机双盲分为对照组(A)与观察组(B、C、D),每组50例。A组用0．25％布比卡因(1．5mg／kg)配伍0．0625mg／ml樱粟碱(0．0375mg／kg)和0．25mg／ml地塞米松(0．1．5mg／kg),B、C、D组按序分别用0．25％、0．375％和0．5％罗哌卡因(1．50mg／kg、2．25mg／kg和3．00mg／kg)。臂丛阻滞均采用一针穿刺单次给药法[(40±5)ml]。观察4组注药后1、2、3、6、12h 5个时点运动与感觉阻滞深度,3、6、9、12、15、18、21、24h 8个时点VAS评分效果。结果4组比较,运动阻滞深度A组>B组<C组<D组,5个时点A、B组1h<2h>3h>6h>12h,C、D组1h<2h<3h>6h> 12h(P<0．01);感觉阻滞起效时间A组<D组<C组<B组(P<0．05;P<0．01),作用维持时间A组>D组>C组>B组(P<0．01);VAS评分4组各时点均成渐进性升高A组<D组<C组<B组(P<0．01)。结论4组均具有不同程度的动静分离现象,除0．25％罗哌卡因组外,0．375％和0．5％罗哌卡因组,对臂丛运动与感觉阻滞深度均比0．25％布比卡因、0．0625mg/ml罂粟碱和0．25mg／ml地塞米松三药联用组高;麻醉止痛与术后镇痛,不论何种浓度、剂量的罗哌卡因亦比布比卡因、罂粟碱和地塞米松三药联用时效短。

Objective To compare different concetrations of ropivacaine with bupivacaine combined with dexamethesone and papaverine on brachial plexus block, to research long -acting separation block between sensation and motion on the war wound need to long distance transport. Methods The 200 patients needed to tendon repair and function reestablish were randomly divided into four groups （50/ each） in double blind form. In group A,i.e the control group,2.5 bupivacaine （1.5mg/kg） combined with 0.0625mg/nd papaverine （0.0375mg/kg） and （0.25mg/ml） dexamethesone（0.15mg/kg）;in group B,C and D, the experimental groups, 0.25%,0.375% and 0.5% ropivaeaine （1.5mg/kg,2.25mg/kg and 3mg/kg） were administered respectively.One single injection was used in brachial plexus block through axillary approach,and the dosage was （40±5）ml. The effect of braehial plexus separation block at 1,2,3,6, and 12hr after injection of drug and the VAS assessment scoring were recorded at 3,6,9,12,15,18,.21 and 24hr after finishing braehial plexus block were compared, Results The effect of motor block in group A became greater than that in group B; The effect of motor block in group B became greater than that in group C and D （P〈0.01）;the onset time of block to sensory component of the braehial plexus in four groups was shorter in the descending order as A,D,C to B（P〈0.01）：the inducing time become greater and greater in the order as A,D,C to B （P〈0.01）; the VAS scoring became greater in the ascending order as A,D,C to B （P〈O.OI）. Conclusions There are different degree separation effect of sensation and motion in the four groups. Sensation and motion block deepness in 0,375% ropivaeaine group and 0.50% ropivacaine group （except 0.25% ropivacaine group） is highter than that in bupivaeaine combined with dexamethesone and papaverine group.The maintenance period and postoperatively analgesic period in bupivacaine combined with dexamethesone and papaverine group are longer than that of in different concertations ropivacaine groups.