低浓度局部麻醉药物对肩关节镜患者肌间沟臂丛神经阻滞后膈肌功能的影响

Effect of low concentration local anesthetics on diaphragm function after interscalene brachial plexus block in patients with shoulder arthroscopy

目的比较低浓度局部麻醉药物和高浓度局部麻醉药物肌间沟臂丛神经阻滞的效果和膈神经阻滞率。方法选择择期肩关节镜手术患者58例,男23例,女35例,年龄18~80岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。根据使用局部麻醉药物的浓度分成低浓度组(n=29)和高浓度组(n=29)。低浓度组用0.25%的罗哌卡因15 mL进行超声引导下肌间沟臂丛神经阻滞;高浓度组用0.5%的罗哌卡因15 mL进行超声引导下肌间沟臂丛神经阻滞。比较两组的臂丛感觉阻滞范围、术中及术后24 h镇痛药用量、镇痛持续时间;术前和术后深呼吸时的膈肌活动度、用力肺活量、血氧分压、血二氧化碳分压;术后并发症发生率等指标。结果高浓度组镇痛持续时间长于低浓度组,且差异具有统计学意义(P<0.05)。臂丛感觉阻滞范围、术中及术后24 h镇痛药用量差异无统计学意义(P>0.05)。术前和术后深呼吸时的膈肌活动度、功能肺活量、血氧分压、血二氧化碳分压,术后并发症发生率等差异无统计学意义(P>0.05)。结论与高浓度局部麻醉药物相比,降低局部麻醉药物的浓度,不能降低膈神经阻滞率,不能减少阿片类药物的用量,不能减少术后并发症发生率,但明显缩短了镇痛时间。

Objective To compare the anesthetic effect and phrenic nerve block rate of low concentration local anesthetics and high concentration local anesthetics in interscalene brachial plexus block.Methods A total of 58 patients undergoing elective shoulder arthroscopic surgery were selected,including 23 males and 35 females,aged 18-80 years old,with the American Society of Anesthesiologists gradeⅠ-Ⅱ.They were divided into the low concentration group(n=29)and high concentration group(n=29)according to the local anesthetics concentration.The low concentration group used 15 mL of 0.25%ropivacaine for ultrasound-guided interscalene brachial plexus block;the high concentration group used 15 mL of 0.5%ropivacaine for ultrasound-guided interscalene brachial plexus block.The range of brachial plexus sensory block,intraoperative and postoperative 24 h analgesic dosage,duration of analgesia,diaphragm activity during deep breathing,forced vital capacity,blood oxygen partial pressure,blood carbon dioxide partial pressure before and after surgery and postoperative complication occurrence rate were compared between the two groups.Results The duration of analgesia in the high concentration group was longer than that in the low concentration group(P<0.05).There were no statistically significant differences in the range of brachial plexus sensory block,intraoperative and postoperative 24 h analgesic dosages(P>0.05).There were no statistical differences in diaphragm activity during deep breathing,functional vital capacity,blood oxygen partial pressure,blood carbon dioxide partial pressure before and after surgery.There was no statistical difference in the incidence rate of postoperative complications(P>0.05).Conclusion Compared with high concentration local anesthetics,reducing the concentration of local anesthetics can not reduce the rate of phrenic nerve block,dosage of opioids and incidence rate of postoperative complications,but significantly shortens the analgesic time.