罗哌卡因及布比卡因经超声引导对腋路臂丛神经阻滞患者麻醉效果的研究

Anesthesia effect of ropivacaine and bupivacaine on patients undergoing axillary brachial plexus block guided by ultrasound

目的:探讨罗哌卡因及布比卡因经超声引导对腋路臂丛神经阻滞患者麻醉效果。方法:选取2017年1月至2018年12月大同市第四人民医院麻醉科收治的120例需行上肢手术的患者,男75例,女45例,年龄(46.57±4.58)岁,年龄范围为27~66岁。按照患者入院顺序将患者分为罗哌卡因组与布比卡因组,每组60例。两组患者均在超声引导下完成腋路臂丛神经麻醉,罗哌卡因组应用罗哌卡因,布比卡因组应用布比卡因,比较两组患者感觉阻滞(起效时间、持续时间、完全失效时间)与运动阻滞(起效时间、产生时间、持续时间)各项指标,采用Ramsay镇静评分与视觉模拟评分(VAS)比较两组患者术后2、6、8 h镇静情况及疼痛情况,记录围术期并发症发生情况。结果:两组患者感觉阻滞起效时间、持续时间,运动阻滞的起效时间比较,差异无统计学意义(P>0.05);罗哌卡因组感觉阻滞的完全失效时间[(465.28±42.25)min]、运动阻滞持续时间[(268.59±39.25)min]长于布比卡因组[(356.58±43.69)min、(206.51±28.59)min],运动产生时间[(12.36±2.13)min]短于布比卡因组[(18.59±2.69)min],差异均有统计学意义(P<0.05);罗哌卡因组术后2 h[(3.14±0.61)分]、6 h的Ramsay镇静评分[(2.61±0.45)分]高于布比卡因组[(2.51±0.31)分、(2.13±0.26)分],差异有统计学意义(P<0.05),两组患者8 h的Ramsay镇静评分比较,差异无统计学意义(P>0.05);术后2 h[(1.26±0.26)分]、6 h[(1.58±0.52)分]、8 h的VAS[(2.11±0.71)分]低于布比卡因组[(1.68±0.34)分、(2.31±0.71)分、(2.43±0.56)分],差异均有统计学意义(P<0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:经超声引导下腋路臂丛神经阻滞麻醉中应用罗哌卡因术后麻醉效果更长,镇静效果更佳,临床麻醉中可优先考虑,但其运动阻滞时间较长,若患者有早期肢体活动需求当考虑改用布比卡因。

Objective To investigate the anesthetic effect of ropivacaine and bupivacaine on patients undergoing axillary plexus block guided by ultrasound.Methods A retrospective study was performed on 120 cases of patients who were admitted in the Anesthesiology of Datong Fourth People′s Hospital,and underwent upper limb surgery from January 2017 to December 2018.There were 75 males and 45 females,aged(46.57±4.58)years old,ranging 27 to 66 years old.According to the order of admission,the patients were divided into the ropivacaine group and bupivacaine group,with 60 cases in each group.The two groups of patients underwent axillary brachial plexus nerve anesthesia under ultrasound guidance.The ropivacaine group of patients received ropivacaine,the bupivacaine group of patients were given bupivacaine.The indexes of sensory block(onset time,duration,complete failure time)and motor block(onset time,onset time,duration)were compared between the two groups.The Ramsay sedation score and visual analogue scale(VAS)at 2,6 and 8 hours after operation were compared,and the perioperative complications were recorded.Results There was no significant difference in onset time,duration of sensory block and onset time of motor block between the two groups(P>0.05).In the ropivacaine group,the total failure time of sensory block[(465.28±42.25)minutes],the duration of motor block[(268.59±39.25)minutes]was longer than that of the bupivacaine group[(356.58±43.69)minutes,(206.51±28.59)minutes],and the exercise generation time[(12.36±2.13)minutes]was shorter than that of the bupivacaine group[(18.59±2.69)minutes],with statistically significant differences(P<0.05).The Ramsay sedation score at 2 hours[(3.14±0.61)points]and 6 hours[(2.61±0.45)points]in the ropivacaine group was higher than that of the bupivacaine group[(2.51±0.31)points and(2.13±0.26)points],with statistically significant differences(P<0.05).The Ramsay sedation score at 8 hours in the two groups showed no statistically significant differences(P>0.05).VAS at 2 hours[(1.26±0.26)minutes],6 hours[(1.58±0.52)minutes]and 8 hours[(2.11±0.71)minutes]were lower than those in the bupivacaine group[(1.68±0.34)minutes,(2.31±0.71)minutes and(2.43±0.56)minutes],with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Ropivacaine is more effective and sedative in axillary brachial plexus block anesthesia under ultrasound guidance.It is preferable to use bupivacaine in clinical anesthesia,but the time of motor block is longer.Bupivacaine should be considered if patients need early limb movement.