超声引导锁骨上臂丛阻滞不同浓度罗哌卡因对膈肌移动度的影响

Effects of different concentrations of ropivacaine on diaphragmatic excursion in supraclavicular brachial plexus block under ultrasound guidance

目的观察超声引导锁骨上臂丛阻滞使用不同浓度罗哌卡因对同侧膈肌移动度和麻醉效果的影响。方法选择拟行锁骨上臂丛阻滞的择期上肢短小手术的患者30例。采用抽签法随机分为A、B和C3组，每组各10例．臂丛阻滞分别使用0．500％、0．375％和0．250％罗哌卡因，均为20ml。在高频超声引导下行锁骨上臂丛阻滞，观察臂丛起效时间和临床阻滞效果。用超声测定阻滞前后的同侧平静呼吸的膈肌移动度。结果A组患者的麻醉起效时间最短，而C组患者所需的麻醉起效时间最长（P〈0．01）。C组神经阻滞效果和麻醉效果显著差于A组和B组（P〈0．05）。A组患者在阻滞后5～90min期间膈肌移动度显著低于阻滞前，有5例患者膈肌无移动，处于完全麻痹状态。B组患者阻滞后5～30min、C组患者阻滞后5～20min时膈肌移动度显著低干阻滞前，均无膈肌完全麻痹病例。A组患者阻滞后膈肌移动度显著低于B、C组（P〈001）。结论超声引导的锁骨上臂丛阻滞采用0．375％罗哌卡因起效较快．麻醉效果好。对膈肌移动度影响较轻，是该径路合适的局麻药选择。

Objective To investigate the effects of different concentrations of ropivacaine in supraclavicular brachial plexus block （SBPB） under ultrasound guidance on ipsilateral diaphragmatic excursion and anesthetic efficacy. Methods Thirty ASA Ⅰ- Ⅱ patients scheduled for the upper extremity surgery were randomized into three groups by drawing lots （n=10 in each group）. SBPB were performed with ropivacaine 20 ml, with the concentrations of 0.5% （Group A）, 0.375% （Group B） and 0.25% （Group C）, respectively. The ipsilateral diaphragmatic excursions of the patients under eupnea were measured with the high fre- quency ultrasonography before and after SBPB. Otherwise, the onset times and the clinical efficacy of SBPB were also observed. Results The onset times of anesthesia in Group A were the shortest, while those in Group C were the longest （P〈0.01）. The effi- cacy of nerve block and anesthetic potency in Group C were worse than those in other two groups （P〈0.05）. In Group A, the ex- tent of diaphragmatic excursion was significantly reduced during 10 - 90 rains after SBPB, with five patients whose diaphragma were completely paralysed. The extent of diaphragmatic excursion in Group B and Group C were significantly decreased during 10 - 30min and 10 - 20min after SBPB, respectively, with no case of complete diaphragma paralysis. After SBPB, the extent of diaphragmatic excursion in Group C was significantly lower than those in Group B and Group C （P〈0.01）. Conclusion Supra- clavicular brachial plexus block under ultrasound guidance using 0.375% ropivacaine is an appropriate choice, with less change in the diaphragmatic excursion, shorter onset time and better anesthetic efficacy.