超声引导下膈神经阻滞治疗中枢性呃逆的罗哌卡因最低有效浓度

The minimum local anesthetic concentration of ropivacalne for ultrasound-guided phrenic nerve block in the treatments of central hiccup

目的探讨超声引导下膈神经阻滞治疗中枢性呃逆的罗哌卡因最低有效浓度。方法采用序贯实验法,选取脑出血术后且有呃逆发作的患者。罗哌卡因起始浓度为0.25%,各相邻浓度间的比率为1.3,容量为4 ml。所有患者超声定位左侧前斜角肌表面膈神经。注药后20 min内呃逆终止判定有效。若此例阻滞有效,则下一例罗哌卡因降低1个浓度;若阻滞无效则改用1.5%利多卡因4 ml行同侧膈神经阻滞,呃逆终止则下一例升高1个浓度;呃逆没有终止则常规药物治疗,8 h后行右侧膈神经阻滞,并此例患者不纳入统计范围,下一例患者继续使用当前浓度,以此类推。将首次罗哌卡因阻滞有效者纳入有效组(A组),利多卡因补充治疗者纳入无效组(B组)。记录各患者用药浓度及阻滞效果,ED50及95%CI的计算依照Dixon和Brownlee的方法。结果超声引导下应用罗哌卡因膈神经阻滞治疗中枢性呃逆安全、有效、用药量少,超声引导膈神经阻滞治疗中枢性呃逆的罗哌卡因95%CI为0.267%~0.335%。结论超声引导膈神经阻滞治疗中枢性呃逆的罗哌卡因最低有效浓度为0.299%。

Objective To determine the minimum local anesthetic concentration of ropivacalne for ultrasound-guided phrenic nerve block in the treatments of central hiccup.Methods In this experiment,sequential experimental method was used to select patients with hiccup after the operation of cerebral hemorrhage.The starting concentration of ropivacaine was 0.25%.The ratio between adjacent concentrations was 1.3.The superficial phrenic nerve on the left anterior scalene muscle of all patients were located by ultrasound.The predetermined concentration of ropiacaine 4 ml was injected.After twenty minutes,whether the injection works or not was judged by observing the symptom of all patients.If the first one is effective,the next injection dose will be decreased one concentration gradient.If the block was not effective,then 4 ml of 1.5%lidocaine will be injected at the same lateral phrenic nerve.If the block is still not effective,the next injection will be ropivacaine with increased one concentration gradient.If the hiccups still did not end,the routine drug treatment will be used.At the same time,with the approval of the patients'family,after eight hours,we will take the right phrenic nerve block.Then this case will not be included in the data statistic.The next patient continues to use the same initial concentration ropivacaine.The effective cases were included in effective group(group A)while the cases with lidocaine supplement were divided into invalid group(group B).The drug concentration,blocking effect,median effective dose(ED50)and 95%confidence intervals(CI)were calculated according to Dixon and Brownlee methods.Results Ultrasound-guided application of ropivacaine for phrenic nerve block for central hiccup is safe,effective and requires little medication.95%CI of ultrasound-guided phrenic nerve block for central hiccup is 0.267%-0.335%.Conclusions The minimum effective concentration of ropivacaine in the treatment of central hiccup was 0.299%.