低浓度罗哌卡因用于臂丛阻滞对肌腱转位重建手术效果的临床研究

目的：探究罗哌卡因用于臂丛阻滞麻醉时产生感觉与运动有效分离效果的合适浓度及配方,并总结低浓度罗哌卡因用于臂丛阻滞麻醉时对肌腱转位重建手术效果的影响。方法：选取2011年以来采用肌间沟法臂丛神经阻滞麻醉后施行肌腱转位重建手术患者100例,利用双盲随机方式将所有患者分为4组,A、B、C和D组各25例。A组麻醉时采用质量分数为0.25浓度的单独布比卡因液（1.5 mg/kg）,含0.0625 mg/m L浓度的罂粟碱混合液,为本次研究对照组;B组为低浓度组,配成质量分数为0.25浓度罗哌卡因液;C组为中浓度组,麻醉时用质量分数为0.5浓度罗哌卡因液;D组为高浓度组,麻醉时用质量分数为0.75浓度罗哌卡因液。通过VAS评分系统来评定麻醉后患者的感觉功能,并在臂丛阻滞后120 min、240 min、480 min三个时间段,分别测定肌肉收缩、肌腱张力和关节活动范围,按肌力分级标准评定肌力。根据上面两项指标来确定产生感觉与运动有效分离效果的合适浓度及配方;手术完成后,所有患者均获得随访7~20个月,对患者恢复状况进行评定,从而判定低浓度罗哌卡因用于臂丛阻滞麻醉时对肌腱转位重建手术效果的影响。结果：B组麻醉后感觉功能与运动功能得到有效分离,较A、C、D组的效果更好;对患者术后恢复状况进行随访,结果中A组、B组、C组和D组的优良率分别为80%、96%、88%和84%。结论：罗哌卡因浓度为0.25%时,用于臂丛阻滞麻醉能产生感觉与运动有效分离的最佳效果;且此时肌腱转位重建手术的疗效更显著,患者恢复更好。

The Clinical Research on the Effect of Low Concentration Ropivacaine for Brachial Plexus Block on the Tendon Transposition Reconstruction Surgery

Objective：To explore the appropriate concentration and formulation of ropivacaine in effective separation of the sensory and motor for brachial plexus block anesthesia and to summarize the effect of low concentrations ropivacaine for brachial plexus block anesthesia in the tendon transposition reconstruction surgery. Methods：100 cases of tendon transposition recon-struction surgery with interscalene brachial plexus block anesthesia,enrolled in our department since 2012,were randomly divid-ed into 4 groups（A,B,C and D）through the double - blind method,25 patients in each group. Group A（ the control group） was given bupivacaine solution（mass fraction of concentration：0. 25;1. 5mg/ kg）alone and mixed papaverine solution（concen-tration：0. 0625mg/ ml）for anesthesia. Group B（the low concentration group）was given ropivacaine solution（mass fraction of concentration：0. 25）for anesthesia. Group C（medium concentration group）and Group B（the high concentration group ）were given ropivacaine solution with the concentration mass fraction of 0. 5 and that with concentration mass fraction of 0. 75 ,respec-tively,for anesthesia. The sensory function of patients after anesthesia was evaluated through VAS scoring system,and muscle contraction,tendon tension and range of motion were measured 120,240 and 480 minutes after brachial plexus block,with mus-cle strength assessed according to muscle strength grading standards. The suitable concentration and formulation for the effective separation of sensory and motor were determined on the basis of the two indicators above. After the surgery,all the patients were offered a follow - up of 7 - 20 months for the assessment of their recovery status so as to determine the effect of low concentration ropivacaine for brachial plexus block on the tendon transposition reconstruction surgery. Results：The sensory function and mo-tion kinetic energy were effectively separated after anesthesia in group B,with a separation effect much better than that in group