罗哌卡因复合羟考酮注射液应用于臂丛神经阻滞的临床效果观察

发布时间：2018-02-08 09:57

  本文关键词： 罗哌卡因 羟考酮 臂丛神经阻滞 临床观察　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:0.5%盐酸罗哌卡因注射液复合少量盐酸羟考酮注射液应用于臂丛神经阻滞的临床效果观察。方法:选用我院2016.06-2016.12期间于手足外科需行上肢手术,并需要进行麻醉的择期手术患者160人,该160人选择年龄介于18-50岁之间,性别无特殊选择,麻醉ASA I-II级,签署知情同意书后,将所选患者随机分为两组,分别记为A组、B组。患者入室评估无明显异常,行必须的监测后,超声引导下于患侧锁骨上窝处行神经阻滞,其中入选A组患者使用含有0.5mg盐酸羟考酮注射液的0.5%盐酸罗哌卡因注射液20ml,B组使用单纯0.5%罗哌卡因注射液20ml,穿刺过程未损伤患者神经、血管,注射完成后可见局麻药物完全包绕臂丛神经束。如发生以下情况时将患者踢出统计范围:1、药物注射过程中出现明显神经刺激症状的患者;2、药物注射过程中出现局麻中毒症状或有局麻药物中毒倾向的患者;3、神经穿刺过程中药物回抽有血,无论调整后是否阻滞成功,考虑排除蛋白、血液等相关干扰因素,此类患者排除统计范围之列;4、由于过度肥胖,或过度消瘦不能安全、明确的将局麻药物注射至神经周围的患者;5、过度紧张,不能完全配合的患者。将以上患者排除后,对余下患者进行统计。分别记录穿刺结束后5min、15min、30min时阻滞区域桡骨茎突处对100Pa的压强(即1牛的压力作用于2ml针头)下的痛觉NRS评分、10℃下手背处温觉感受、肘部肌力评分、不适反应(如头晕、皮肤瘙痒等)以及患者生命体征。统计学方法:应用SPSS 19.0统计软件进行分析,计量资料时采用均数±标准差(`x±s)来表示,多组间均数的比较采用单因素方差进行分析,组间多重数值比较采用Tukey检验。计数资料比较采用χ2检验。P0.05为差异有统计学意义。结果:A组在神经阻滞完成后5min时疼痛NRS评分较B组明显下降(P0.05),15min时NRS评分较B组明显下降(P0.05),30min时疼痛NRS评分无明显差异;5min时受神经阻滞测皮肤温觉感受A组较B组明显迟钝,15min温觉感受较B组明显迟钝,30min时A组与B组温觉感受无明显差异;5min时A组肌力较B组下降明显,15min时A组肌力较B组下降明显,30min时A组与B组肌力均为0级,无统计学差异;围术期两组患者均未出现明显不适及副作用,无统计学差异;A组患者生命体征较术前波动范围小于20%较B组有明显下降(P0.05)。结论:目前采用超声引导下神经阻滞,将以前的完全盲探性操作进展为可视化操作,使得臂丛神经阻滞成功率更高,0.5%盐酸羟考酮注射液复合0.5mg盐酸羟考酮注射液用于臂丛神经阻滞于单独使用0.5%盐酸羟考酮注射液阻滞效果最终两组患者无明显差异,但复合0.5mg盐酸羟考酮注射液应用于臂丛神经阻滞时起效更快,患者围术期情绪更稳定,患者舒适度更高,围术期并发症无明显增多,仍不失为临床应用的好方法。
[Abstract]:Objective: to observe the clinical effect of 0.5% ropivacaine hydrochloride injection combined with a small amount of hydroxycodone hydrochloride injection in brachial plexus block. There were 160 patients who needed anaesthesia for elective operation. The patients were divided into two groups randomly after signing the informed consent form, who had chosen between 18 and 50 years old, had no special choice of sex, had no special choice of sex, and had signed the informed consent form. The patients were recorded as group A and B respectively. There was no obvious abnormality in the assessment of the patients' room. After the necessary monitoring, the supersonic nerve block was performed at the supraclavicular fossa on the affected side. Group A received 0.5% ropivacaine hydrochloride injection 20ml containing 0.5 mg hydroxycodone hydrochloride injection. Group B received only 0.5% ropivacaine injection 20ml. The nerve and blood vessels of the patients were not damaged during puncture. Local anesthetic can be seen completely wrapped around the brachial plexus nerve bundle after injection. If the following conditions will be kicked out of the statistical range of 1, the drug injection of patients with obvious symptoms of nerve stimulation, drug injection process appear. Patients with symptoms of anaesthesia or with a tendency to be poisoned by local anesthetic drugs have their blood drawn back in the course of nerve puncture. Whether the adjustment is successful or not, taking into account the exclusion of protein, blood and other related interference factors, such patients exclude the statistical scope of 4, because of excessive obesity, or excessive weight loss is not safe, The patients who were injected with local anesthetic drugs into the peripheral nerves were overstressed and could not cooperate completely. After the above patients were excluded, The pain NRS scores at 100Pa in the styloid process of the radius at the end of 5 min and 15 min and 30 min after the puncture were recorded, respectively. The pain NRS scores at 10 鈩，

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