罗哌卡因复合不同剂量地塞米松用于上肢手术肌间沟臂丛神经阻滞的效果对比

Comparison of different doses of dexamethasone combined with ropivacaine in intermuscular groove brachial plexus block

目的探讨罗哌卡因复合不同剂量地塞米松在肌间沟臂丛神经阻滞中应用的效果。方法纳入2020年3月~2021年7月我院收治行择期上肢手术并行肌间沟臂丛神经阻滞的病人100例,按照随机数字表法分为对照组和A、B、C、D共计5组,各20例;对照组给予0.5%罗哌卡因20 ml+生理盐水1 ml;A组给予0.5%罗哌卡因20 ml+地塞米松1 mg,B组给予0.5%罗哌卡因20 ml+地塞米松2 mg,C组给予0.5%罗哌卡因20 ml+地塞米松3 mg,D组给予0.5%罗哌卡因20 ml+地塞米松4 mg;比较各组病人麻醉效果、应激相关指标及不良反应情况。结果5组病人在麻醉前、麻醉后5分钟、麻醉结束后6小时内平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);A、B、C、D 4组病人感觉、运动神经阻滞维持时间明显长于对照组,且随着地塞米松剂量增加,感觉、运动神经阻滞维持时间逐渐延长,差异有统计学意义(P<0.05);术后24小时各组去甲肾上腺素(NE)、肾上腺素(E)及皮质醇(Cor)水平均不同程度升高,但C、D两组NE、E、Cor水平低于对照组、A组、B组,差异有统计学意义(P<0.05);5组术中及术后不良反应比较,差异无统计学意义(P>0.05)。结论地塞米松联合罗哌卡因复合臂丛神经阻滞麻醉能够明显延长病人神经阻滞时间、降低机体应激反应,且在地塞米松安全剂量范围内,随着剂量增加,这种优势更加明显。

Objective To explore the effect comparison of dexamethasone combined with ropivacaine in intermuscular groove brachial plexus block.Methods A total of 100 patients who underwent elective upper limb surgery in orthopedics department of our Hospital from March 2020 to July 2021 were enrolled.They were divided into control group according to the random number table method and groups A,B,C,and D,20 cases in each.The control group was given 0.5%ropivacaine 20 ml+saline 1 ml;group A was given 0.5%ropivacaine 20 ml+dexamethasone 1 mg,group B was given 0.5%ropivacaine 20 ml+dexamethasone 2 mg,and group C was given 0.5%ropivaca 20 ml+dexamethasone 3 mg,group D was given 0.5%ropivacaine 20 ml+dexamethasone 4 mg.Compare the effects of anesthesia,stress-related indicators and adverse reactions of patients in each group.Results There were no obvious differences in the mean arterial pressure(MAP)mmHg and heart rate(HR)between the five groups of patients before anesthesia,5 min utes after anesthesia,and 6 hours after anesthesia(P>0.05).The maintenance time of sensory and motor nerve blocks in patients in groups A,B,C,and D was obvious longer than control group,and with the increase of dexamethasone dosage,the maintenance time of sensory and motor nerve blocks was gradually extended(P<0.05).The levels of norepinephrine(NE),epinephrine(E),and cortisol(Cor)in each group increased to varying degrees at 24 hours after operation,but the levels of NE,E,and Cor in the two groups were lower than those in the control group,A,B three groups,the difference is statistically significant(P<0.05).There was no significant difference in adverse reactions between the five groups during and after surgery(P>0.05).Conclusion Dexamethasone combined with ropivacaine and brachial plexusblock anesthesia can significantly prolong the nerve block time and reduce the body’s stress response in patients,and it is within the safe dose range of dexamethasone more obvious.