超声引导下罗哌卡因锁骨上臂丛神经阻滞对老年患者膈肌功能的影响

Effect of Ropivacaine in Ultrasound-guided Supraclavicular Brachial Plexus Block on Diaphragmatic Function of the Elderly

目的观察并比较不同浓度与容量的罗哌卡因在超声引导下行锁骨上臂丛神经阻滞时对老年患者膈肌功能的影响,为确定使用合适的罗哌卡因的剂量与容量提供依据。方法选择拟行右上肢择期手术的老年患者60例,随机分为2组:0.375%罗哌卡因20 mL组(A组)和0.5%罗哌卡因15 mL(B组),每组30例。所有患者在超声引导下行锁骨上臂丛神经阻滞,记录和比较2组臂丛各主要神经根的感觉阻滞和运动阻滞的起效时间与持续时间,并观察与比较2组不良反应的发生情况。采用M型超声测量阻滞前和阻滞后30 min时2组平静呼吸和用力呼吸的右侧膈肌移动度,通过观察膈肌移动度的变化来反映膈肌麻痹情况,计算和比较2组膈肌麻痹率。结果 B组感觉阻滞起效时间、运动阻滞起效时间均明显少于A组(P<0.05);2组感觉阻滞和运动阻滞持续时间差异无统计学意义(P>0.05);阻滞30 min后A组和B组分别有20例(66.7%)和19例(63.3%)出现平静呼吸时部分或完全膈肌麻痹,而差异无统计学意义(P>0.05);但在深呼吸状态时B组膈肌完全麻痹发生率明显高A组,差异有统计学意义(P<0.05)。结论 0.375%罗哌卡因20 mL与0.5%罗哌卡因15 mL在超声引导下行锁骨上臂丛神经阻滞均有理想的臂丛阻滞效果,而0.375%罗哌卡因20 mL在深呼吸时引起的膈肌麻痹较少,为罗哌卡因的合理应用提供参考。

Objective To observe the effects of ropivacaine of different concentrations and volumes in ultrasound-guided supraclavicular brachial plexus block on diaphragmatic function of the elderly.Methods 60 elderly for right upper limb selective operation were selected and were randomly divided into 2 groups:group A(20 mL of 0.375%ropivacaine)and group B(15 mL of 0.5%ropivacaine),30 in each;ultrasound-guided supraclavicular brachial plexus block was performed on all the cases in both groups;the sensory block of the main nerve roots of the brachial plexus,the onset time and duration of motor block were recorded and the occurrence of adverse reactions was observed,a comparative study was made between the 2 groups;M-mode ultrasound was applied in measuring the right diaphragmatic movement of the cases in the 2 groups before block and 30 min after block;the diaphragmatic paralysis rates in the 2 groups were calculated and compared.Results The onset times of sensory block and exercise block in group B were significantly shorter than those in group A(P<0.05);There was no statistical difference in duration of sensory block and motor block between the 2 groups(P>0.05);30 minutes after block,partial or complete diaphragmatic paralysis was found in 20 cases(66.7%)in group A and 19 cases in group B(63.3%),the difference was of no statistical significance(P>0.05);the complete paralysis rate of diaphragm in deep breathing in group B was significantly higher than that in group A(P<0.05).Conclusions 20 mL of 0.375%ropivacaine and 15 mL of 0.5%ropivacaine can produce the ideal effect in ultrasound-guided supraclavicular brachial plexus block while 20 mL of 0.375%ropivacaine causes less diaphragmatic paralysis in deep breathing.