臂丛神经阻滞麻醉复合舒芬太尼曲马多用于上肢手术的临床观察

The Clinical Observation of Sufentanil and Tramadol Combined Brachial Plexus Block Anesthesia for Upper Limb Operation

目的:观察臂丛神经阻滞复合舒芬太尼曲马多用于上肢手术的临床效果。方法:上肢手术臂丛神经阻滞麻醉168例随机均分M组(静注曲马多1 mg/kg、舒芬太尼0.1μg/kg)、F组(静注舒芬太尼0.1μg/kg)、C组(静注0.9%氯化钠注射液2 ml),每组56例,术毕均给予静脉自控镇痛(PCIA)舒芬太尼0.05μg/(kg·h),观察三组患者给药后5 min(T0)、术毕(T1)、术后30 min(T2)、术后60 min(T3)、术后120 min(T4)、术后180 min(T5)、术后240 min(T6)各时段的Sp O2、R、SBP、HR及VSA评分,记录寒战发生率及神经阻滞效果。结果:M组各时段VSA评分及神经阻滞效果评级优于F组,差异均有统计学意义(P<0.05);M组寒战发生率明显低于F组,比较差异有统计学意义(P<0.05)。结论:在臂丛神经阻滞行上肢手术中,静脉复合舒芬太尼曲马多,能有效地阻止痛觉过敏和异常疼痛的发生,从而达到超前镇痛的目的,同时可减少寒战反应的发生。

Objective：To observe the effect of Sufentanil complex Tramadol combined brachial plexus block anesthesia for upper limb operation.Method：168 upper limb operation patients with brachial plexus block anesthesia were randomly divided into group M（Tramadol 1 mg/kg,Sufentanil 0.1 μg/kg）,group F（Sufentanil 0.1 μg/kg）,group C（saline 0.9% 2 ml）,56 cases in each group,they were treated with Sufentanil[0.05 μg /（kg·h）,PCIA] in end of the surgery.The Sp O2,R,SBP,HR,VSA scores in nerve block of 5 min after Drug Administration（T0）,the end of operation（T1）,30 min after operation（T2）,60 min after operation（T3）,120 min after operation（T4）,180 min after operation（T5）,240 min after operation（T6） and rate of shivering,effect of nerve block were observed.Result：VSA scores in different time and effect of nerve block in the group M were better than those in the the group F（P〈0.05）.The incidence of shivering in the group M was significantly lower than that in the group F,there was statistical significance（P〈0.05）.Conclusion：In the operation of upper limb Brachial plexus block anesthesia,combined Sufentanil complex Tramadol can effectively prevent hyperalgesia and allodynia,so as to achieve the purpose of preemptive analgesia,also can reduce the occurrence of shivering response.