相同浓度不同容量罗哌卡因超声引导锁骨上臂丛神经阻滞对膈肌麻痹的影响

发布时间：2018-11-29 11:15

【摘要】：目的观察超声引导锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)使用相同浓度不同容量罗哌卡因对膈肌麻痹的影响。方法选择拟行右上肢骨折术后取内固定装置术的患者72例,男32例,女40例,年龄18~65岁,ASA I或II级。随机分为两组:0.375%罗哌卡因20ml组(A组)和0.375%罗哌卡因30ml(B组),每组36例。所有患者在超声引导下行锁骨上臂丛神经阻滞,记录臂丛各主要神经根的感觉阻滞、运动阻滞的起效时间和持续时间,并观察两组患者不良反应的发生情况。采用M型超声测量阻滞前、阻滞后30min时两组平静呼吸和用力呼吸的膈肌移动度,通过观察膈肌移动度的变化来反映膈肌麻痹情况,并计算膈肌麻痹率。结果两组患者感觉阻滞起效时间、感觉阻滞和运动阻滞持续时间差异均无统计学意义。B组运动阻滞起效时间明显短于A组(P0.05)。阻滞后30min A组和B组分别有12例(33.3%)和22例(61.1%)患者出现膈肌麻痹,B组膈肌麻痹率明显高于A组(P0.05)。结论 0.375%罗哌卡因20 ml与30ml在超声引导下行锁骨上臂丛神经阻滞均可达到理想的臂丛阻滞效果,0.375%罗哌卡因20 ml引起膈肌麻痹较少。
[Abstract]:Objective to observe the effect of different volume ropivacaine on diaphragmatic paralysis induced by supraclavicular brachial plexus block (supraclavicular brachial plexus block,SCBPB). Methods Seventy-two patients (32 males and 40 females) with, ASA I or II grade of 18 ~ 65 years old were selected from 72 patients (32 males and 40 females) who planned to perform internal fixation after operation of right upper limb fracture. They were randomly divided into two groups: 0.375% ropivacaine 20ml (group A) and 0.375% ropivacaine 30ml (group B) with 36 cases in each group. All the patients underwent supraclavicular brachial plexus block under the guidance of ultrasound to record the onset and duration of sensory block and motor block of the main nerve roots of the brachial plexus and to observe the occurrence of adverse reactions in the two groups. The diaphragm movement of two groups during 30min before and after block was measured by M-mode ultrasound. The changes of diaphragm movement were observed to reflect the situation of diaphragmatic paralysis and the rate of diaphragmatic paralysis was calculated. Results there was no significant difference in the onset time of sensory block and the duration of sensory block and motor block between the two groups. The onset time of motor block in group B was significantly shorter than that in group A (P0.05). There were 12 cases (33.3%) and 22 cases (61.1%) of 30min group A and B respectively after block. The rate of diaphragmatic paralysis in group B was significantly higher than that in group A (P0.05). Conclusion both 0.375% ropivacaine 20 ml and 30ml can achieve ideal brachial plexus block under ultrasound guidance, and 0.375% ropivacaine for 20 ml can cause diaphragmatic paralysis.
【作者单位】：安徽医科大学附属解放军第九八临床学院;
【基金】：南京军区医学科技创新课题(15S008)
【分类号】：R614

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