布比卡因加入地塞米松对蛛网膜下腔神经阻滞麻醉下行下肢手术患者神经阻滞时效的影响

Influence of bupivacaine combined with dexamethasone on nerve block retardation of lower limb surgery patients with subarachnoid block anesthesia

目的探讨布比卡因加入地塞米松对蛛网膜下腔神经阻滞麻醉(腰麻)下行下肢手术患者神经阻滞时效的影响。方法选取南京市江宁医院2015年12月—2016年9月择期行腰麻下下肢手术患者90例,根据腰麻使用药物和给药方式不同将患者分为C组、D1组和D2组,各30例。C组蛛网膜下腔注入布比卡因10 mg;D1组蛛网膜下腔注入布比卡因10 mg+地塞米松粉剂5 mg;D2组蛛网膜下腔注入布比卡因10 mg,同时蛛网膜下腔注入地塞米松5 mg。比较3组患者神经阻滞情况,即麻醉最高阻滞平面(胸)、麻醉起效时间(T_1)、达最高平面时间(T_2)、感觉阻滞持续时间(T_3)及术后镇痛持续时间(T_4)、运动阻滞持续时间至运动恢复的时间(T_5),手术时间、术中出血量、补液量及不良反应发生情况。结果 3组患者阻滞最高平面(胸)、T_1、T_2比较,差异无统计学意义(P>0.05);D1组T_3、T_4长于C组、D2组(P<0.05);C组与D2组T_3、T_4比较,差异无统计学意义(P>0.05),3组患者T_5比较,差异无统计学意义(P>0.05)。3组患者手术时间、术中出血量、补液量及不良反应发生率比较,差异无统计学意义(P>0.05)。结论布比卡因加入地塞米松可延长腰麻下行下肢手术患者感觉阻滞时间和术后镇痛持续时间及不影响运动阻滞持续时间,且不良反应少。

Objective To observe the influence of bupivacaine combined with dexamethasone on nerve block retardation of lower limb surgery patients with subarachnoid block anesthesia. Methods A total of 90 cases of lower limb surgery patients with subarachnoid block anesthesia were selected from December 2015 to September 2016 in Jiangning Hospital of Nanjing,which were divided into C group,D1 group and D2 group according to different anesthesia treatments,30 cases in each group. C group was injected with bupivacaine 10 mg,D1 group was injected with bupivacaine 10 mg ＋ dexamethasone 5 mg; D2 group was injected with bupivacaine 10 mg, and than given dexamethasone 5 mg. The nerve block retardation [maximum anesthesia block for anesthesia,time of onset of anesthesia（ T1）,up to the maximum plane time（ T2）,sensory block duration（ T3）,duration of postoperative analgesia（ T4）,duration of exercise block to the recovery time of exercise（ T5） ],and opration time,intraoperatve blood loss,intraoperative fluid replacement and the incidence of adverse reactions were compared among the three groups. Results No significant difference of maximum anesthesia block for anesthesia, T1 or T2was found among three groups（ P 〉 0. 05）; D1 group of T3,T4 were longer than C group, D2 group（ P 〈 0. 05）; no significant difference of T3,T4 was found between C group,D2 group（ P 〉 0. 05）,no significant difference of T5 was found among three groups（ P 〉 0. 05）. No significant difference of opration time,intraoperatve blood loss,intraoperative fluid replacement or the incidence of adverse reactions was found among three groups（ P 〉 0. 05）. Conclusion Bupivacaine combined with dexamethasone can prolong sensory block time and the duration of postoperative analgesia of lower limb surgery patients with subarachnoid block anesthesia without affecting the duration of motor block,and with less adverse reactions.