不同局麻药的颈丛阻滞效果及对Q-T间期和Q-T离散度的影响

Anesthetic efficacy of different local anesthetics and their effects on Q-T interval and Q-T dispersion during cervical plexus block

目的:研究不同局麻药用于颈丛神经阻滞的效果及其对Q-T间期和Q-T离散度(Q-Td)的影响.方法:60例ASAⅠ或Ⅱ级拟在颈丛阻滞下行甲状腺肿物切除患者,随机分为4组(每组15例):罗哌卡因组(Ⅰ组),布比卡因组(Ⅱ组),罗哌/利多卡因组(Ⅲ组),布比/利多卡因组(Ⅳ组),各组分别用3.75g/L罗哌卡因、3.75g/L布比卡因、3.75g/L罗哌卡因/10.0g/L利多卡因及3.75g/L布比卡因/10.0g/L利多卡因20mL行颈丛神经阻滞,观察麻醉效果及并发症发生情况,记录麻醉前(T0),麻醉即刻(T1),麻醉后10min(T2),30min(T3),1h(T4)及手术结束即刻(T5)的HR,MAP,SpO2,RR,PetCO2,同时记录各时间点的Q-T,Q-Td及校正后的Q-Td(Q-Tcd).结果:Ⅰ,Ⅱ组;Ⅲ,Ⅳ组麻醉效果相似(P>0.05),均能满足手术要求;各组对抬头肌力的影响:Ⅱ组强于I组(P<0.05),Ⅳ组与Ⅲ组差异无统计学意义(P>0.05).各组患者HR,MAP在麻醉后均有不同程度升高,均在临床安全范围;SpO2,RR,PetCO2差异无统计学意义(P>0.05).Q-T间期、Q-Td,Q-Tcd麻醉后均延长,其中以II组延长最为明显(P<0.01).结论:不同局麻药及其配伍用于颈丛神经阻滞均能满足临床麻醉需要,罗哌卡因、罗哌/利多卡因对Q-T间期、Q-Td影响小,临床应用更为安全.

AIM： To investigate the anesthetic efficacy of different local anesthetics and their effects on Q-T interval and Q-T dispersion during cervical plexus block. METHODS： Sixty patients （ASA Ⅰ or Ⅱ ） scheduled for excision of thyrophyma with cervical plexus block were randomly divided into 4 groups （ 15 in each group） ： ropivacaine group （group I ）, bupivacaine group （group lI ） , ropivacaine/lidocaine group （ group III ） and bupivacaine/ lidocaine group （groupiv） . Cervical plexus block was performed with 3.75 g/L ropivacaine, 3.75 g/L bupivacaine, 3.75 g/L ropivacaine/10.0 g/L lidocaine and 3.75 g/L bupivacaine/10.0 g/L lidocaine, respectively. The efficacy and complications were investigated. HR, MAP, SpO2, RR and PetCO2 were recorded before operation （ T0 ） , at the time of anesthesia （ T1 ） , 10 min （ T2 ） , 30 min （ T3 ）, 1 h （ T4 ） after anesthesia and at the end of operation （T5 ）. Q-T interval, Q-Td and Q-Ted were recorded at the same time. RESULTS： There was no significant difference between group Ⅰ and group Ⅱ , group Ⅲ and group Ⅳ about the efficacy of anesthesia and complications （ P 〉 0.05 ）. The motor block of cervical muscles in group Ⅱ was significant than that in group Ⅰ （P 〈 0. 05 ）. HR and MAP increased in 4 groups after anesthesia and SpO2, RR, PetCO2 displayed no obvious changes. Q-Td and Q-Ted were longer after anesthesia in 4 groups and the change was most significant in group Ⅱ （ P 〈 0.01 ）. CONCLUSION： The anesthetic efficacy of commonly used local anesthetics in cervical plexus block is satisfactory. Ropivacaine and ropivacaine/lidocaine exert little effect on Q-T interval and Q-Td, indicating their suitability in clinical application.