低浓度罗哌卡因与布比卡因在改良颈浅丛阻滞中的对比研究

目的: 比较低浓度的罗哌卡因与布比卡因应用于改良颈浅丛阻滞麻醉的效果和安全性。方法: 选择ASAⅠ~Ⅱ级,甲状腺次全切除术80例,随机分为0.25%罗哌卡因组(R组)和0.25%布比卡因组(B组),每组40例;2组均采用改良颈浅丛阻滞法(即将局麻药注射在胸锁乳突肌后缘中点皮下)阻滞双侧颈浅丛。观察2组阻滞起效时间、麻醉效果及心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度(SpO₂)变化情况;对抬头肌力的影响及并发症。结果: 阻滞起效时间R组为(6.33 ±0.92) min,B组为(4.75 ±0.92) min,差异有统计学意义(P < 0.01);阻滞麻醉有效率R组为95.0%,B组为97.5%,差异无统计学意义(P > 0.05)。与同组T₀时间点比较,B组在T₂、T₃时间点HR均增快(P < 0.05和P < 0.01)。2组在T₂、T₃和T₄时间点的DBP、SpO₂均较T₀升高(P < 0.05~P < 0.01),2组不同时间各指标差异均无统计学意义(P > 0.05)。B组有4例发生抬头肌力减弱,但头颈仍能自主活动;2组均无并发症发生。结论: 罗哌卡因应用于改良颈浅丛阻滞,效果确切,安全性高,更具优越性。

A comparative study of improved superficial cervical plexusblock anesthesia with ropivacaine or bupivacaine

Objective：To compare the efficacy and safety of low concentration of ropivacaine and bupivacaine used in improving bilateral superficial cervical plexus nerve block anesthesia.Methods：Eighty ASA Ⅰ or Ⅱ adult patients who underasent subtotal thyroidectomy were randomly divided into group R with 0.25% ropivacaine and group B with 0.25% bupivacaine（n=40,each）.Two groups were treated with the method of improved bilateral superficial cervical plexus block,the local anesthetic drug directly injected in middle point of rear edge of sternocleidomastoid muscle by subcutaneous injection.The efficacy,muscle strength of neck and complications of cervical plexus block were assessed by anesthetist and surgeon.Heart rate（HR）,and systolic blood pressure（SBP）,diastolic blood pressure（DBP）,pulse oxygen saturation（SpO2） were monitored before block anesthesia（T0）,10 minutes after block anesthesia（T1）,incision of skin（T2）,and operation（T3）,and after operation（T4）.Results：There was significantly difference about the onsetime between group R（6.33±0.92）min and B（4.75±0.92）min（P0.01）,without statistical difference about the efficacy of anesthesia between group R（95.0%）and B（97.5%）,and complications（P0.05）.Compared with T0 point,HR significantly increased at T2,T3 point in B group（P0.05）.DBP and SpO2 both increased compared with T0 at T2,T3,T4 in two groups（P0.05-P0.01） without statistical difference of other indicators between two groups（P0.05）.Moreover muscle strength of 4 cases case of muscle strength weakened can be found in group B.Conclusions：Ropivacaine is more suitable for improved bilateral superficial cervical plexus block anesthesia due to its efficacy and safety.