罗哌卡因与舒芬太尼混合液用于臂丛神经阻滞麻醉的观察

Clinical Observation of Mixture Solution of Ropivacaine and Sufentanil in Brachial Plexus Nerve Block Anesthesia

目的探讨甲磺酸罗哌卡因与舒芬太尼混合液用于臂丛神经阻滞麻醉在上肢手术中应用的可行性与安全性。方法择期行上肢手术患者100例,术前ASAⅠ～Ⅱ级,随机双盲法分为试验组与对照组,试验组50例用0.894%甲磺酸罗哌卡因15 mL+舒芬太尼10μg(1 mL)+0.9%氯化钠注射液14 mL制成30 mL混合药液A。对照组50例用0.894%甲磺酸罗哌卡因15 mL+0.9%氯化钠注射液15mL制成30 mL混合药液B,对比观察麻醉后生命体征及镇痛、镇静、麻醉效果评分,比较心电图、动脉血氧饱和度、平均动脉压、心率等指标。结果两组患者注药后各时间点平均动脉压、心率、动脉血氧饱和度的差异无统计学意义(P>0.05)。在麻醉后10 min试验组疼痛评分明显低于对照组,麻醉起效较快。试验组患者在注药后20 min镇静效果明显优于对照组,差异有统计学意义(P<0.05)。麻醉效果方面,试验组优良率96.00%,而对照组86.00%,两组比较有显著性差异(P<0.01)。两组麻醉过程中均未出现不良反应。结论在行臂丛神经阻滞麻醉时,用罗哌卡因复合舒芬太尼比单用罗哌卡因镇痛作用起效快、时间长、镇静作用好,可减少镇静催眠药物的用量,降低不良反应发生率,是一种安全、有效的神经阻滞方法。

Objective To explore the feasibility and safety of mixture solution of ropivacaine mesylate with sufentanil for brachial plexus nerve block anesthesia used in the upper extremity surgery. Methods 100 cases of elective upper extremity surgery with ASA Ⅰ- Ⅱ level were divided into the experimental group and control group by the random double-blind method. The experimental group （50 eases） was given 30 mL of the mixture solution A prepared by 0. 894% ropivacaine mesylate 15 mL plus sufentanil 10μg （1 mL） plus O. 9% sodium chloride injection 14 mL. The control group （50 cases） was given 30 mL of the mixture solution B prepared by 0. 894% ropivacaine mesylate 15 mL plus 0.9% sodium chloride injection 15 mL. The vital signs, scores of analgesic, sedative and anesthetic effects after anesthesia were observed and compared between the two groups. Moreover, the changes of ECG, SPO2, MAP, HR, and other indicators after anesthesia were compared. Results The differences in MAP, HR, SPO： at different timepoints between the two groups had no statistical significance （P〉0. 05）. The pain score at 10 min after anesthesia in the experimental group was significantly lower than that in the control group, anesthesia effect was faster. The sedative effect at 20 rain after drug administration in the experi-mental group was obviously superior to that in the control group, the difference was statistically significant （P 〈0. 05）. In the anesthesia effect, the excellent and good rate was 96.00% in the experimental group and 86.00% in the control group with statistically significant differences between the two groups （P 〈0. 01 ）. Two groups all did not appear adverse reactions during anesthesia. Conclusion In con-ducting brachial plexus nerve block anesthesia, the combination use of ropivacaine mesylate and sufentanil has fast onset time of analge-sia, long analgesic time and good sedative effect than pure ropivacaine mesylate, can reduce sedative-hypnotic drug dosage and the oc-currence rate of adverse reactions, which is a safe and effective method of nerve block.