三种不同局麻药复合舒芬太尼用于颈丛神经阻滞的比较

目的:以小剂量舒芬太尼复合三种不同局麻药用于颈丛神经阻滞,比较观察其麻醉效果和不良反应。方法:择期行甲状腺手术的患者90例,随机分为A组、B组、C组,每组30例。三组均于入室20min后行双侧C4横突一针法颈丛神经阻滞,局麻药分别用0.25%布比卡因(A组),0.25%罗哌卡因(B组),0.25%左旋布比卡因(C组),三组均加入舒芬太尼0.2μg/kg,混合液共20ml。每侧C4横突注药6ml,后退针至颈阔肌表面扇形注射4ml,双侧同时阻滞。记录颈丛神经阻滞前(T0)、颈丛神经阻滞5min(T1)、10min(T2)、15min(T3)、30min(T4)、60min(T5)时的SBP、DBP、HR、SpO2。结果:T1～T4时三组SBP、DBP、HR均明显高于T0时(P<0.05),T0～T4时三组之间比较差异无显著性(P>0.05);SpO2三组各时段之间比较差异无显著性(P>0.05),均维持于95%以上。三组患者麻醉效果优良率均为100%。结论:小剂量舒芬太尼复合布比卡因、罗哌卡因和左旋布比卡因用于颈丛神经阻滞均能增强麻醉效果,并使循环更趋稳定,但罗哌卡因和左旋布比卡因安全性更好一些。

Comparion of Three Different Local Anesthetics Combined with Sufentanil in Cervical Plexus Block

Objective：Use three different local anesthetics in cervical plexus block combined with sufentanil of low-dose to compare their efficiency and adverse reaction.Methods：90 patients undergoing elective thyroid surgery were randomly allocated into A group,B group and C group（each 30 cases）.The patients of the three groups were all given cervical plexus block through C4 transverse of both sides by one needle method.The three local anesthetics were 0.25% bupivacaine（A group）,0.25% ropivacaine（B group）,0.25% levobupivacaine（C group）.The three groups were all combined with sufentanil by 0.2μg/kg,and the mixture was 20ml.Each side of the C4 transverse was given 6ml,and gave 4ml fan-shapedly when the needle move back to the surface of the platysma muscle.Recorded the SBP,DBP,HR,SpO2.Before cervical plexus block（T0）,and 5min after the block（T1） and 10min after（T2）15min after（T3）30min after（T4）60min after（T5）.Results：The SBP,DBP,HR of the three groups were significantly higher at the time of T1~T4 than T0（P0.05）,and the difference between the three groups was not significant at the time of T0~T4（P0.05）;The difference of SpO2 of the three groups at all the time points was not significant（P0.05）,And the SpO2 were all maintained at 95% or higher.The anesthesia satisfaction rate of the three groups were all 100%.Conclusion：Low-dose sufentanil can enhance the anesthesia effect when combined with bupivacaine,ropivacaine and levobupivacaine in cervical plexus block,and make circulation more stable,but the ropivacaine and levobupivacaine were much more safer.