超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

超声引导锁骨上臂丛神经阻滞行前臂手术时罗哌卡因有效浓度的探究

目的 在前臂手术的患者中,使用超声引导下锁骨上臂丛神经阻滞麻醉方法,测定其局麻药罗哌卡因的半数有效浓度(EC₅₀)。 方法 筛选择期前臂手术患者64例,ASA分级I或II级,年龄42.25±15.35岁,体重64.20±9.90kg,身高165.75±8.41cm。研究过程中始终由同一位麻醉医师采用超声引导下锁骨上臂丛神经阻滞方法,局麻药为罗哌卡因30ml,起始浓度为0.50%,浓度增减每级为0.05%。测定桡神经、正中神经、尺神经、前臂内侧皮神经、前臂外侧皮神经等前臂主要5根神经自穿刺注药后30分钟内的阻滞效果。运用序贯法,从0.50%浓度开始,若5根神经均完全阻滞,则下一病例减一级浓度;若有1根神经发生不完全阻滞,则下一病例增加一级浓度。运用Probit回归统计法计算超声下该神经阻滞的罗哌卡因的半数有效浓度。 结果 前臂手术患者在超声引导下行锁骨上臂丛神经阻滞局麻药罗哌卡因EC₅₀为0.518%,95%CI为0.496%~0.547%。 结论 此结果可为临床在锁骨上臂丛神经阻滞中选择合适的药物浓度提供参考。     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度

目的 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度.方法 择期上肢手术患者50例,年龄19～72岁,体重45～83 ks,身高150～181 cm,ASA分级Ⅰ或Ⅱ级.超声引导下行臂丛神经阻滞,定位成功后注入罗哌卡因30 ml,初始浓度0.50%,浓度变化梯度为O.05%,阻滞有效则下一例采用低一级浓度,阻滞无效,则下一例采用高一级浓度.采用Prebit法计算超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度及其95%可信区间.结果 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%,95%可信区间为0.393%～0.477%.结论 超声引导下罗哌卡因臂丛神经阻滞的半数有效浓度为0.436%.

Abstract：

Objective To determine the median effective concentration (EC50) of ropivacaine for ultrasound-guided brachial plexus block.Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 19-72 yr, weighing 45-83 kg, scheduled for upper extremity surgery under brachial plexus block guided by ultrasound, were enrolled in this study. Brachial plexus block was performed under the guidance of ultrasound. After successful location, ropivacaine 30 ml was injected. EC50 of ropivacaine was determined by up-and-down sequential method. The initial concentration was 0.50% . Each time the concentration increased/decreased by 0.05% . EC50 of ropivacaine required for ultrasound-guided brachial plexus block and 95% confidence interval were calculated using Probit analysis.Results The EC50 of ropivacaine resulting in complete block of the brachial plexus nerve was 0.436%(95% confidence interval 0.393%-0.477% ). Conclusion The EC50 of ropivacaine is 0.436% for ultrasoundguided brachial plexus block.     

不同麻醉方法在胎窘时施行急症剖宫产对脐动脉血气的影响

目的：观察不同麻醉方法在胎窘时施行急症剖宫产对脐动脉血气的影响。方法：选择美国麻醉医师协会病情估计分级（ASA）1级已诊断为胎儿宫内窘迫的剖宫产孕产妇40例，分为腰麻（SA）组20例和连续硬膜外（CEA）组20例。在胎儿娩出后立即抽取新生儿脐动脉血进行血气分析。结果：SA组脐动脉血气的pH、PO2明显高于CEA组（P＜0．01），SA组的PCO2明显低于CEA组（P＜0．01），两组BE、HCO3^-1无显著性差异（P＞0．05）。结论：对急症剖宫产尤其有胎儿宫内窘迫者选择腰麻较硬膜外麻醉对新生儿更为有利。     

超声引导下阴部神经阻滞在后尿道成形术中的应用

目的探讨超声引导下侧卧位经臀部入路阴部神经阻滞在成人后尿道成形术中的应用价值。方法选取拟行后尿道成形术的患者120例,采用随机数字表法分为阴部神经阻滞组（PNB组）与对照组,每组各60例。PNB组术前行超声引导下侧卧位双侧PNB。两组均行喉罩全身麻醉,术后均予静脉自控镇痛（patient-controlled intravenous anesthesia, PCIA）。记录术中舒芬太尼第一次追加时间及总用量,术后不同时间点的视觉模拟评分（visual analogue scale, VAS）,术后补救镇痛次数,患者满意度及不良反应的发生率。结果PNB组首次阻滞成功率96.67%,平均操作时间为（7±2.1） min。与对照组相比,PNB组首次追加舒芬太尼的时间明显延长,舒芬太尼的总用量明显减少（P＜0.01）;术后1、6、12、24 h镇痛效果较好（P＜0.05）;术后24 h内追加镇痛药物次数明显减少,首次疼痛时间（VAS评分≥4分）延长（P＜0.05）;患者满意度明显提高（P＜0.05）;不良反应发生率差异无统计学意义（P＞0.05）。结论超声引导下侧卧位经臀部入路PNB操作便捷、成功率高,可降低后尿道成形术患者术中阿片类药物的使用量,并提供有效的术后镇痛效果,加速患者下床活动,且不增加不良反应发生率。     

甲磺酸罗哌卡因和盐酸罗哌卡因肌间沟臂丛神经阻滞的比较

目的 观察0.596%甲磺酸罗哌卡因和0.5%盐酸罗哌卡因在超声引导下行肌间沟臂丛神经阻滞的效果.方法 60例上肢手术行肌间沟臂丛麻醉的患者,随机均分成两组:A组给予0.596%甲磺酸罗哌卡因30 ml;B组给予0.5%盐酸罗哌卡因30 ml.比较两组感觉及运动阻滞起效时间、阻滞程度、运动恢复时间、镇痛持续时间和不良反应.结果 A组尺神经感觉阻滞起效时间显著快于B组[(38.30±14.65)min vs.(48.03±22.34)min](P<0.05).注药60 min A组尺神经感觉完全阻滞29例(96.7%),显著多于B组的20例(66.7%)(P<0.05).结论 0.596%甲磺酸罗哌卡因的尺神经感觉阻滞优于0.5%盐酸罗哌卡因.