硫酸镁在肌间沟臂丛神经阻滞上肢手术中的应用

Analgesia effect of magnesium sulfate in ultrasound-guided interscalene brachial plexus block in limb surgery

目的观察超声引导下硫酸镁肌间沟臂丛神经阻滞（ISBPB）对上肢手术麻醉效果和镇痛时间的影响。方法选择ISBPB复合喉罩全麻拟行上肢手术的患者54例,男34例,女20例,年龄37~73岁,ASAⅠ或Ⅱ级,随机均分为两组：硫酸镁组（M组）,超声引导下ISBPB,用药0.5%罗哌卡因8ml（40mg）加10%硫酸镁2ml（0.5g）;对照组（N组）,超声引导下ISBPB,用药0.5%罗哌卡因8ml加生理盐水2ml（40mg）。待神经阻滞完全起效后,静脉诱导插入喉罩通气,术中七氟醚（呼末MAC 0.8）维持。分别记录局麻药注射后感觉和运动阻滞的起效时间和持续时间,术后镇痛时间,术后4、8、12、24h的疼痛视觉模拟评分（VAS）以及术后不良反应。结果两组感觉和运动阻滞起效时间差异无统计学意义,M组的感觉阻滞持续时间和镇痛时间明显长于N组（P〈0.05）。术后8、12、24h M组的VAS评分明显低于N组（P〈0.05）。两组的术后补救用镇痛药、芬太尼用量差异无统计学意义。两组恶心呕吐的发生率差异无统计学意义。所有患者均未出现肌力减弱、麻木、瘙痒、寻麻疹等不良反应。结论超声引导下ISBPB注射0.5%罗哌卡因复合硫酸镁能延长感觉阻滞持续时间,降低术后疼痛程度,延长镇痛时间。

Objective To observe the anesthesia and analgesia effect of ultrasound guided interscalene brachial plexus block（ISPSP）on upper extremity surgery.Methods Fifty-four patients（male34cases,female 20 cases,aged 37-73 years,ASA gradeⅠ orⅡ）scheduled for elective upper limb surgery under ISPBP combined with general anesthesia were randomly assigned into two groups：magnesium sulfate group（group M,n=27）and control group（group N,n=27）.0.5% ropivacaine8ml（40mg）＋10% magnesium sulfate 2ml（0.5g）were used in group M,0.5%ropivacaine 8ml＋ normal saline 2ml（40mg）were used in group N.After the effects of ISBPB were confirmed,patients were inserted laryngeal mask under intravenous induction.Anesthesia was maintained by inhaling sevoflurane（MAC 0.8）during the operation.The onset time of sensory and motor block,duration of sensory and motor block,duration of analgesia,pain visual analogue digital score（VAS）4,8,12,24 hours after operationand complications were recorded.Results Duration of sensory block and duration of analgesia of group M was significantly longer than those of group N（P〈0.05）.The patients VAS score of 8,12,24 hours after surgery in group M was significantly lower than that on group N（P〈0.05）.Onset time of sensory and motory block of both groups was similar.Conclusion 0.5%ropivacaine combined with magnesium sulfate in ultrasound-guided ISPBP can extend the duration of sensory block,reduce postoperative pain,as well as prolong analgesia time.