小剂量芬太尼复合低浓度布比卡因在改良颈丛阻滞中的应用

目的:探讨小剂量芬太尼复合低浓度布比卡因用于改良颈丛阻滞,能否提高颈丛阻滞效果,减少心血管副作用。方法:择期甲状腺腺瘤行甲状腺次全切除术患者70例,ASAⅠ级~Ⅱ级,随机分为两组,每组35例。两组用改良颈丛阻滞(患侧阻滞深丛,双侧阻滞浅丛),观察组(A组)用0.25%的布比卡因20ml含芬太尼1μg/kg;对照组(B组)用0.25%的布比卡因20ml。两组局麻药均加入地塞米松5mg。连续监测血压(BP)、心电图(ECG)、脉搏、血氧饱和度(SpO2),记录阻滞起效时间、作用持续时间、麻醉效果、心血管副反应(BP升高、HR增快)情况。结果:研究组阻滞效果达优率高于对照组,感觉阻滞起效时间比对照组缩短,作用时间比对照组延长(P<0.05),研究组中高血压、心动过速的发生率,明显低于对照组(P<0.05)。结论:应用小剂量芬太尼复合低浓度布比卡因可提高颈丛阻滞效果,减少心血管副作用。

Application of Low-dose Fentanyl Combined with Bupivacaine in Cervical Plexus Block Anaesthesia

Objective To explore whether low-dose fentanyl combined with bupivacaine may achieve reliable cervical plexus block anesthesia and the influence on heart rate and blood pressure.Methods 70 patients with thyroid adenoma of ASAⅠ～Ⅱ,who were determined to be given subtotal thyroidectomy under cervical plexus block anesthesia were randomized into two groups with 35 each.Group A received 0.25% bupivacaine 20 ml plus low-dose fentanyl (1 μg/kg),and Group B received 0.25% bupivacaine 20 ml alone. Puncture was located at C4 block lateral superficial cervical plexus and bilateral deep cervical plexuses.The changes of heart rates and blood pressure were monitored.The onset time ,duration of sensory block,the quality of analgesia and side effects were recorded.Results The onset of sensory blockade in group A was significantly faster than those in group B (P<0.05), Duration of sensory block was significantly longer in group A than that in group B (P<0.05),the quality of analgesia in group A was better than that in group B (P<0.05).The rate of increases HR and BP more remarkable in group B than those in group A, 9 patients of group B and 2 of group A needed heterothrapy Because of adverse reaction.Conclusions A low-dose fenanyl combination with bupivacaine proviedes better cervical plexus block anesthesia for subtotal thyroidectomy and has less cardiovascular responses than bupivacaine alone.