不同浓度甲磺酸罗哌卡因用于肌间沟臂丛神经阻滞的临床研究

目的借助神经刺激器定位肌间沟臂丛阻滞,观察3种浓度甲磺酸罗哌卡因的阻滞效果和不良反应,为临床寻找一种合适浓度配方。方法将90例ASAⅠ～Ⅱ级行上肢手术的患者随机分为A、B、C三组（每组30例）,分别采用0.25%、0.33%和0.40%甲磺酸罗哌卡因,行神经刺激器定位肌间沟臂丛神经阻滞麻醉。观察感觉神经阻滞时间、运动阻滞时间及阻滞程度、镇痛持续时间、不良反应。结果与A组比较,B组和C组感觉神经阻滞时间延长差异有统计学意义（P〈0.05）,C组运动阻滞时间延长差异有统计学意义（P〈0.05）,C组镇痛持续时间明显延长（P〈0.05）。A组有5例术中有疼痛不适,需要用镇痛药镇痛;B组发生2例霍纳综合征;C组发生3例霍纳综合征和2例呼吸困难,经面罩吸氧后缓解。未发生其他并发症。结论 借助神经刺激器定位肌间沟臂丛阻滞,3种浓度甲磺酸罗哌卡因均可满足手术的要求,但0.33%甲磺酸罗哌卡因更适合于肌间沟臂丛阻滞麻醉。

Clinical research of the different concentrations of ropivacaine mesylate in interscalene brachial plexus block

Objective To observe the effect and adverse reaction of 3 different concentrations of ropivacaine mesylate in interscalene brachial plexus block oriented by nerve stimulator,looking for the appropriate concentration of clinical treatment.Methods 90 ASA physical statusⅠ～Ⅱ children who were undergoing selective upper limb operations were divided into 3 groups（n=30） randomly： A、B、C groups received 0.25%、0.33% and 0.40% ropivacaine mesylate respectively.The duration of sensory block、the duration and degree of motor block、the duration of pain intensity and adverse reaction were recorded.Results Compared with group A,The duration of sensory block in group B and group C and the duration of motor block in group C were showed a significant difference（P0.05）.The duration of pain intensity in group C was significantly longer（P0.05）.5 cases of group A had intraoperative pain and needed analgesic drug;2 cases of Horner syndrome in group B;3 cases of Horner syndrome and 2 cases of dyspnea in group C and were alleviated after mask inhalation of oxygen without other adverse reaction.Conclusion the effect of 3 different concentrations of ropivacaine mesylate in interscalene brachial plexus block oriented by nerve stimulator can all meet the surgical requirement,but 0.33% ropivacaine mesylate is more suitable for interscalene brachial plexus block.