布比卡因阻滞运动神经的半数有效剂量的相关影响因素

发布时间：2018-01-24 19:22

  本文关键词： 蛛网膜下腔 布比卡因注射液 年龄 浓度 运动神经阻滞　出处：《武汉大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：1、探讨在成年人(18-83岁)蛛网膜下腔麻醉中布比卡因运动神经阻滞的半数有效剂量(ED5o),评估年龄对运动神经阻滞ED5o的影响。2、探讨在年轻组和老年组中局麻药浓度对布比卡因运动神经阻滞的ED5o的影响。方法：选择需要蛛网膜下腔麻醉且无此麻醉禁忌症的非孕成年患者233人,分为三个不同部分来研究。1、年龄对布比卡因运动神经阻滞的半数有效剂量的影响选择129名患者,根据年龄分成6组(20-30岁；31-40岁；41-50岁；51-60岁；61-70岁；71-80岁),每组的第一例患者都选择0.75%布比卡因7.5mg,并根据前一例运动神经阻滞的效果调整后一例布比卡因的剂量,每次的增加或减少的剂量为0.75mg。运动神经阻滞的判定方法是根据注射完后5分钟以内任何一个下肢的运动评分,评分标准根据Bromage评分和髋部运动功能评分。ED5o运用Dixon和Massey方法和逻辑回归方法测算出。同时记录无创血压和心率、最高的麻醉平面和运动阻滞持续时间。2、布比卡因浓度对年轻患者运动神经阻滞的半数有效剂量的影响选择40名年轻患者(18-40岁),根据布比卡因浓度分成两组(0.75%；0.375%),麻醉药的浓度都选择0.75%布比卡因,根据需要增加一倍的生理盐水配备成0.375%布比卡因溶液。余试验方法同1。3、布比卡因浓度对老年患者运动神经阻滞的半数有效剂量的影响选择64名老年患者(≥70岁),根据布比卡因浓度分成三组(0.75%；0.375%；0.25%),麻醉药的浓度都选择0.75%布比卡因,根据需要增加一倍或两倍的生理盐水配备成0.375%或0.25%布比卡因溶液。余试验方法同1。结果：1、年龄对布比卡因运动神经阻滞的半数有效剂量的影响蛛网膜下腔布比卡因运动神经阻滞的ED5o值在20-30岁为10.22 mg(95%CI: 9.96-10.49 mg),在31-40岁为9.52 mg (95%CI:9.02-10.07 mg),在41-50岁为8.37 mg (95%CI:7.56-9.26 mg),在51-60岁为7.30 mg (95%CI:6.84-7.79 mg),在61-70岁为6.55 mg (95%CI:6.01-7.13 mg),在71-80岁为5.78 mg (95%CI: 5.01-6.67 mg) 。六组中最大感觉阻滞平面在5分钟时是L1-L2,10分钟时是T10-L1。各组中运动神经阻滞的持续时间存在差异(P0.05)。2、布比卡因浓度对年轻患者运动神经阻滞的半数有效剂量的影响0.75%布比卡因组和0.375%布比卡因组蛛网膜下腔布比卡因运动神经阻滞的ED50值分别为9.998mg和8.890 mg。3、布比卡因浓度对老年患者运动神经阻滞的半数有效剂量的影响0.75%布比卡因组、0.375%布比卡因组和0.25%布比卡因组蛛网膜下腔布比卡因运动神经阻滞的ED50值分别为6.10 mg (95%CI:5.68,6.55 mg)、6.04 mg (95%CI:5.76,6.33 mg)和5.43 mg (95%CI:5.16,5.71 mg)。结论：蛛网膜下腔布比卡因运动神经阻滞的ED50值随着年龄的增加而逐渐减少。布比卡因浓度对不同年龄患者运动神经阻滞的ED50的影响是一致的,不论在年轻患者还是老年患者,随着布比卡因浓度的降低,其相对应的ED50值也会逐渐降低。
[Abstract]:Objective to investigate the median effective dose of bupivacaine motor nerve block during subarachnoid anesthesia in adults aged 18-83 years. To evaluate the effect of age on motor nerve block (ED5o). Objective: to investigate the effect of local anesthetic concentration on ED5o of bupivacaine motor nerve block in young group and senile group. Methods: 233 non-pregnant adult patients who needed subarachnoid anesthesia and did not have this contraindication were selected. The effect of age on the half effective dose of bupivacaine motor nerve block was studied in three different parts. 129 patients were divided into 6 groups according to their age. 31-40 years of age; 41-50 years; 51-60 years; 61-70 years; The first patients in each group were given 0.75% bupivacaine 7.5 mg and the dose of bupivacaine was adjusted according to the effect of motor nerve block. The increased or decreased dose was 0.75 mg per time. Motor nerve block was judged by motor score of any lower extremity within 5 minutes after injection. The score was calculated according to Bromage score and hip motor function score. ED5o was measured by Dixon and Massey methods and logical regression method. Noninvasive blood pressure and heart rate were recorded at the same time. Effects of bupivacaine concentration on the median effective dose of motor nerve block in young patients 40 young patients aged 18-40 years were selected. According to the concentration of bupivacaine, the rats were divided into two groups. 0.75% bupivacaine was selected for the concentration of the anesthetic, and the physiological saline was doubled to 0.375% bupivacaine solution according to the need. The remaining test methods were the same as 1.3. Effect of bupivacaine concentration on half effective dose of motor nerve block in elderly patients 64 elderly patients (鈮，

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