罗哌卡因-亚甲蓝区域阻滞结合手法推拿治疗肩周炎的临床研究

Clinical Study of Ropivacaine and Methylene Blue Performed Regional Block Combined with Manipulation Treated for Periarthritis Humeroscapulayis

目的观察罗哌卡因-亚甲蓝复合液行区域阻滞结合手法推拿治疗肩周炎的临床效果,并对3种不同配方所产生的作用进行对比分析。方法96例肩周炎患者被随机分为3组：A组30例,用0.5%罗哌卡因15 ml;B组30例,用0.25%罗哌卡因15 ml;C组36例,用0.25%罗哌卡因13.5 ml＋1%亚甲蓝1.5 ml,分别于喙突、肩峰下、肱骨小结节、肩胛上肌等处选择3-4个痛点行区域阻滞,然后行手法推拿治疗。1次/3 d,5次为1个疗程。治疗过程中采用VAS评分,1个疗程结束后对治疗效果进行综合评定。结果A,C两组在治疗过程中的镇痛效果明显好于B组（P〈0.05）;1个疗程结束后C组治疗有效率与A,B两组比较有显著性差异（P〈0.05）。结论采用罗哌卡因-亚甲蓝复合液行区域阻滞能强化局麻药的作用,不仅能减轻手法推拿治疗期间患者的疼痛,并能明显提高肩周炎患者的治疗效果,具有可行性。

Objective To observe the clinical effect of Ropivacaine and Methylene blue performed regional block combined with Manipulation treated for periarthritis humeroscapulayis, and the function of three different prescriptions were compared. Methods 96 patients between 42 to 65 years with unilateral periarthritis humeroscapulayis were chosen. ASA was Ⅰ-Ⅱ and the course of diseases were between 4 weeks to 2 years. All patients were randomly divided into three groups. Administered 0.5% Ropivacaine to group A （30 patients） ,0.25% Ropivacaine to group B （30 patients） ,and 0.25% Ropivacaine ＋ 1% Methylene blue to group C （36patients） respectively. 3 - 4 ache point of coracoid, acromion, humerus tubercle and levator scapulae muscle which were chosen were performed with regional block. Then performed with Manipulation therapy for 5 min, once every three days and five times each therapeutic period Visual analogous score （VAS） was observed during therapy. Curative effect was integrated assessed with the 6 - point behavioral rating scale （BRS-6） after a period of treatment. Results Analgesic effect in group A and C were obviously better thanthat in group B （ P 〈 0. 05 ）. The curative effect in group C was significantly different from group A and B af- ter a period of treatment （P 〈 0.05 ）. Conclusion Ropivacaine and Methylene blue performed regional block can intensify the effect of local anesthetic. The method will not only lighten the ache reaction during Manipulation therapy, but also can obviously enhance curative effect of these patients with periarthritis humeroscapulayis. It is provided with feasibility.