不同浓度罗哌卡因对老年患者肌间沟臂丛神经阻滞后膈肌运动功能的影响

Effects of different concentrations of ropivacaine on the diaphragmatic motor function in elderly patients after intermuscu-lar sulcus brachial plexus block

目的:比较相同容量不同浓度罗哌卡因对老年患者行肌间沟臂丛神经阻滞镇痛效果和膈肌运动功能的影响。方法:择期行肩关节镜手术患者46例,按随机数字表法分为0.5%罗哌卡因20 ml组(A组,24例)和0.3%罗哌卡因20 ml组(B组,22例),分别于全身麻醉诱导前行超声引导下肌间沟臂丛神经阻滞。记录不同时间点两组患者血流动力学、阻滞后VAS评分、膈肌运动情况及其他不良反应发生率。结果:阻滞30 min内两组患者血流动力学差异无统计学意义(P>0.05);阻滞后20 h内两组患者静息和运动VAS评分及其他不良反应发生率差异无统计学意义(P>0.05);A组患者阻滞后5 min、3 h、6 h、20 h平静呼吸位和最大呼吸位双侧膈肌移动度与阻滞前差异有统计学意义(P<0.05);B组患者阻滞后5 min、3 h、6h平静呼吸位和最大呼吸位双侧膈肌移动度与阻滞前差异有统计学意义(P<0.05);阻滞后3h、20hA组患者膈肌麻痹发生率高于B组(P<0.05);阻滞后5 min、3 h、6 h、20 h A组患者阻滞侧膈肌厚度分数低于阻滞前(P<0.05),阻滞后3、6、20 h对侧膈肌厚度分数高于阻滞前(P<0.05)。阻滞后5min、3h、6hB组患者阻滞侧膈肌厚度分数低于阻滞前(P<0.05),阻滞后3、6 h对侧膈肌厚度分数高于阻滞前(P<0.05)。结论:20 ml 0.5%和0.3%罗哌卡因对于老年患者肩关节镜手术后20 h内镇痛效果相似,但高浓度组患者膈神经麻痹发生率和发生时长显著增高。

Objective To determine the effects of ropivacaine at different concentrations in the same volume on the analgesic effect and diaphragmatic motor function in elderly patients with intermuscular sulcus brachial plexus block.Methods A total of 46 patients who were scheduled for shoulder arthroscopy were selected.According to the random number table method,they were divided a 0.5%ropivacaine 20 ml group(group A,n=24)and a 0.3%ropivacaine 20 ml group(group B,n=22)and received ultrasound-guided intermuscular sulcus brachial plexus block before induction of general anesthesia.Their hemodynamics,Visual Analogue Scale(VAS)scores,diaphragmatic movement and other adverse reactions were recorded at different time points.Results There was no statistical difference between the two groups in hemodynamics within 30 min after block(P>0.05),as well as in VAS scores at resting and during movement and other adverse reaction rate within 20 h after block(P>0.05).Patients in group A presented significant differences in bi-lateral diaphragmatic movement on quiet breathing and maximal expiration 5 min,3 h,6 h and 20 h after block,compared with those before block(P<0.05).Patients in group B also demonstrated significant differences in bilateral diaphragmatic movement on quiet breathing and maximal expiration 5 min,3 h and 6 h after block,compared with those before block(P<0.05).The incidence of diaphrag-matic palsy in group A was higher than that in group B 3 h and 20 h after block(P<0.05).Patients in group A presented a decreased di-aphragmatic thickness fraction at the blocked side 5 min,3 h,6 h and 20 h after block(P<0.05),as well as an increased diaphragmatic thickness fraction at the opposite side 3 h,6 h and 20 h after block,compared with those before block(P<0.05).Patients in group B pre-sented a decreased diaphragmatic thickness fraction at the blocked side 5 min,3 h and 6 h after block(P<0.05),as well as an increased diaphragmatic thickness fraction at the opposite side 3 h and 6 h after block,compared with those before block(P<0.05).Conclusions Similar analgesic effects are found between 20 ml of 0.5%and 0.3%ropivacaine in elderly patients within 20 h after shoulder arthroscopy,but the incidence and duration of diaphragmatic paralysis in patients of the high concentration group significantly increase.