超声引导腋路臂丛阻滞不同剂量效果的观察

发布时间：2018-04-21 04:20

本文选题：超声 + 罗哌卡因　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：研究探讨不同剂量0.5%罗哌卡因在超声引导下腋路臂丛神经阻滞中的效果，并探寻剂量对上臂神经支配效果的影响，以期寻找罗哌卡因在腋路臂丛神经阻滞中的合理剂量。方法：选择符合条件的上肢手术患者75例，年龄16-70岁，体重40-90kg，ASA I-II级，将患者随机分为A、B、C三组，每组25例，其中局麻药剂量为A组20ml，B组30ml，C组40ml，均采用0.5%罗哌卡因，在超声引导下行腋路臂丛神经阻滞。采用一针四点方法将局麻药分别送至肌皮神经，桡神经，正中神经，尺神经周围。其中每个靶点药物剂量为该组局麻药总量的四分之一。记录阻滞操作时间，于注药完毕后30min内每隔五分钟记录臂丛各分支神经支配区域感觉及运动阻滞起效时间（感觉神经阻滞效果评估采用针刺法，运动神经阻滞效果评估采用改良Bromage分级），并评定手术过程中的麻醉效果（优、中、差），随访记录阻滞维持时长及术中、后各种并发症。结果：各组神经阻滞操作时间无统计学差异（P0.05），臂丛各神经分支阻滞有效率接近100%，麻醉效果优等率各组间比较无统计学差异（P0.05），臂外侧上皮神经，臂内侧皮神经及前臂内侧皮神经阻滞起效时间A组明显长于C组（P 0.05），尺神经运动阻滞起效时间B组明显长于C组，有统计学差异（P 0.05）。A、B、C各组上臂皮支间臂外侧上皮神经阻滞起效时间均明显长于臂外侧下皮神经，臂后侧皮神经及臂内侧皮神经（P 0.01），各组内腋神经运动阻滞起效时间明显长于其余运动神经阻滞起效时间（P 0.05）。阻滞维持时间A组，显著短于B、C两组，差异有统计学意义（P 0.05），A，B，C三组之间恶心呕吐发生率无统计学差异（P0.05）。C组女性恶心呕吐的发生率明显大于男性（P 0.05）。各组未见神经损伤等其他并发症，且无一例需改全麻。结论：超声引导腋路臂丛阻滞可达到很完善的阻滞效果，基本依靠单一的麻醉方法完成大部分上肢手术，，同时能保证病人术中的无痛；阻滞中局麻药用量越大，起效相对越快，阻滞维持时间越长，上臂感觉及运动的阻滞效果越好，但并发症发生率有一定增加；综合考虑起效时间、阻滞效果及并发症，30ml局麻药量可能是较好的选择。
[Abstract]:Objective: To study the effect of different doses of ropivacaine in axillary brachial plexus block guided by ultrasound, and to explore the effect of dose on the innervation of upper brachial plexus, in order to find out the reasonable dose of ropivacaine in axillary brachial plexus block. Methods: 75 patients, aged 16-70 years and weighing 40-90 kg / I-II, were randomly divided into three groups: group A (n = 25), group A (n = 25), and group A (n = 25) with local anesthetic dosage of group A (n = 20), group B (n = 30), group C (n = 40), and group C (n = 40) with 0.5% ropivacaine. Axillary brachial plexus block was guided by ultrasound. The local anesthetic was delivered to the musculocutaneous nerve, radial nerve, median nerve and ulnar nerve by a four point method. The dose of each target drug was 1/4 of the total amount of local anesthetics in the group. The operation time of block was recorded, and the onset time of sensory and motor block in the innervation region of brachial plexus was recorded every five minutes in 30min. The effect of motor nerve block was evaluated by modified Bromage classification. The anesthetic effect during operation was evaluated (excellent, moderate and poor). The duration of block and complications during operation were recorded. Results: There was no statistical difference in the operation time of nerve block in each group (P 0.05), the effective rate of nerve branch block in brachial plexus was close to 100, there was no significant difference in the excellent anaesthesia effect among groups (P 0.05). The onset time of medial brachial cutaneous nerve and medial forearm cutaneous nerve block in group A was significantly longer than that in group C (P 0.05), and the onset time of motor block of ulnar nerve in group B was significantly longer than that in group C. There were significant differences in the onset time of the upper arm cutaneous branch interbrachial lateral epithelial nerve block between the upper arm and the lower arm cutaneous nerve. The onset time of motor block of axillary nerve in each group was significantly longer than that of other motor nerve block (P 0.05). The duration of block maintenance in group A was significantly shorter than that in group B (P 0.05). There was no significant difference in the incidence of nausea and vomiting among the three groups (P 0.05). The incidence of nausea and vomiting in group C was significantly higher than that in group C (P 0.05), and the incidence of nausea and vomiting in group C was significantly higher than that in group C (P 0.05). There were no other complications such as nerve injury in each group, and none of them needed general anesthesia. Conclusion: Ultrasound-guided axillary brachial plexus block can achieve a very perfect block effect, basically rely on a single anesthesia method to complete most of the upper limb surgery, at the same time can ensure that the patient during the operation painless, the larger the amount of local anesthetic in block, the faster the effect is. The longer the duration of block, the better the effect of sensory and motor block on upper arm, but the incidence of complications was increased. Considering the time of onset, the effect of block and the dosage of 30 ml local anesthetic may be the better choice.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614;R445.1

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