两种容量罗哌卡因用于超声引导下肌间沟臂丛神经阻滞对膈肌麻痹的影响

Influence of different volumes of 0.375% ropivacaine on diaphragm paralysis by interscalene brachial plexus block under ultrasound guidance

目的探讨在超声引导下使用0.375%罗哌卡因20 ml或30 ml行肌间沟臂丛神经阻滞的效果及对膈肌麻痹的影响。方法选择拟在超声引导下行肌间沟臂丛神经阻滞的右侧前臂手术患者54例,男39例,女15例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为A组(0.375%罗哌卡因20 ml)和B组(0.375%罗哌卡因30 ml),每组27例。记录臂丛各分支神经阻滞起效时间和痛觉阻滞情况,使用超声测量并记录麻醉前、注药后15、30 min时平静呼吸和用力呼吸时膈肌移动度以及RR,记录神经阻滞相关不良反应。结果两组臂丛分支神经痛觉阻滞完全率差异无统计学意义。与A组比较,B组桡神经、腋神经、尺神经阻滞起效时间明显缩短(P<0.05);注药后30 min,B组RR明显增快(P<0.01),平静呼吸和用力呼吸时膈肌移动度均明显减少(P<0.05),膈肌麻痹率明显升高(P<0.05)。结论采用20 ml和30 ml的0.375%罗哌卡因在超声引导下行肌间沟臂丛神经阻滞均能达到理想麻醉效果,但20 ml对膈肌麻痹影响更小。

Objective To investigate the influence of 0.375%ropivacaine 20 ml or 30 ml on diaphragm paralysis and anesthesia effect by interscalene brachial plexus block(ISBPB)under ultrasound guidance.Methods Fifty-four patients with right forearm short surgery,39 males and 15 females,aged 18-65 years,ASA physical statusⅠ-Ⅱ,who were scheduled to undergo ISBPB under ultrasound guidance were enrolled.The patients were randomized into two groups(n=30 for each group):group A with 0.375%ropivacaine 20 ml and group B with 0.375%ropivacaine 30 ml.The diaphragmatic excursion of calm respiration and forced respiration,respiratory rate(RR)in each group were measured and recorded by ultrasound before anesthesia,15 min after injection and 30 min after injection.The onset time,the complete pain block rate of each brachial plexus branch nerve and adverse reactions were recorded.Results The complete pain block rate of each brachial plexus branch nerve had no significant difference between the two groups.Compared with group A,the onset time of block of radial nerve,axillary nerve and ulnar nerve was shorter in group B(P<0.05).There was no significant difference in the rate of complete block of pain in the main branches of brachial plexus between the two groups.Compared with group A,RR was faster at 30 min after injection in group B(P<0.01).The diaphragmatic excursion in group B decreased significantly during quiet breathing and forced breathing(P<0.05).The diaphragm paralysis rate in group B was higher than that in group A(P<0.05).Conclusion ISBPB with 0.375%ropivacaine 20 ml or 30 ml under ultrasound both can achieve ideal anesthesia effect,while 0.375%ropivacaine 20 ml had less effect on diaphragm paralysis.