不同剂量罗哌卡因在超声引导下腋路臂丛神经阻滞中的麻醉效果

Comparison of anesthetic effects and complications of different doses of ropivacaine in axillary brachial plexus block guided by ultrasound

目的比较不同剂量罗哌卡因在超声引导下腋路臂丛神经阻滞中的麻醉效果及并发症的发生情况。方法选取2016年9月至2018年5月期间于四川省骨科医院择期行前臂或手部手术的120例患者作为研究对象,依据随机数字表原则,将患者分为低剂量组(n=40)、中剂量组(n=40)和高剂量组(n=40),采用不同剂量(分别为0.25、0.5、0.75 ml/kg)0.33%罗哌卡因进行局麻。比较三组麻醉效果,并发症发生率,血清肌钙蛋白(cTnI)、心肌酶(CKMB)水平及生命体征的变化。结果高剂量组的感觉阻滞、运动阻滞起效时间短于低剂量组和中剂量组,持续时间长于低剂量组和中剂量组(P<0.05);三组T0、T3时DBP、SBP、HR水平比较差异均无统计学意义(P>0.05),三组T1时DBP、SBP、HR水平均显著低于T0时(P<0.05),低剂量组在T1、T2时DBP、SBP、HR水平均显著高于中剂量组和高剂量组(P<0.05),中剂量组和高剂量组比较差异无统计学意义(P>0.05);低剂量组的总并发症率为5.0%,显著低于中剂量组(20.0%)和高剂量组(25.0%)(P<0.05);给药后低剂量组的血清cTnI、CKMB水平均低于高剂量组和中剂量组(P<0.05)。结论三种剂量罗哌卡因均能满足手术需求,但低剂量的罗哌卡因对生命体征具有稳定作用,且安全性较高。

Objective To compare the anesthetic effects and complications of different concentrations ropivacaine inultrasound-guided axillary brachial plexus block.Methods From September 2016 to May 2018,120 patients who underwent forearm or hand surgery in Sichuan Orthopedic hospital were selected as the study objects.According to the principle of random number table,the patients were divided into low-dose group(n=40),medium dose group(n=40)and high-dose group(n=40).Different doses(0.25,0.5,0.75 ml/kg respectively)of 0.33%ropivacaine was used for local anesthesia.The anesthesia effect,complication rate,serum cardiac troponin I(cTnI)and creatine kinase myoglobin(CKMB)level and vital signs were compared among the three groups.Results The onset time of sensory block and motor block in high dose group was shorter than that in low dose group and medium dose group,and the duration was longer than that in low dose group and medium dose group(P<0.05);there was no significant difference in diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR)levels between the three groups at T0 and T3(P>0.05),and the DBP,SBP and HR levels in the three groups at T1 were significantly lower than those at T0(P<0.05);the level of DBP,SBP and HR in the low dose group was significantly higher than that in the medium dose group and the high dose group(P<0.05),and there was no significant difference between the medium dose group and the high dose group(P>0.05);the overall complication rate in the low dose group was 5.0%,which was significantly lower than that in the medium dose group(20.0%)and the high dose group(25.0%)(P<0.05);after administration,the serum cTnI and CKMB levels in the low dose group were lower than those in the high dose group and medium dose group(P<0.05).Conclusions Three doses of ropivacaine can meet the surgical needs,but low-dose ropivacaine has a stable effect on vital signs and high safety.