摘要
目的观察臂丛神经阻滞复合不同的常用剂量佐剂对于阻滞的效果及安全性评价。方法选取2018-06/2019-06期间洪湖市人民医院单侧上肢手术的患者110例作为研究对象,ASA分级Ⅰ或Ⅱ级,通过随机数字表法将患者随机纳入5个组,每组22例。其中A组为常规局麻药物(0.5%的罗哌卡因),B组为常规局麻药物混入5 mg地塞米松,C组为常规局麻药物混入100 mg曲马多,D组为常规局麻药物混入1/200000的肾上腺素,E组为常规局麻药物混入1μg/kg的右美托咪定。所有患者均采用超声引导下肌间沟及腋路臂丛神经阻滞的麻醉方法。记录患者神经阻滞的起效时间(T_(1))、感觉阻滞的持续时间(T_(2))和运动阻滞的持续时间(T_(3)),并记录患者术后6 h、术后12 h、术后24 h的NRS疼痛评分以及5组患者术后24 h内不良反应的发生情况。结果五组患者麻醉起效时间及运动阻滞持续时间组间比较无统计学意义。B、C、D、E组的感觉阻滞作用持续时间明显高于A组,其中C、E组最长,但是组间无统计学意义。添加佐剂后,麻醉后的不良反应组间无统计学意义(P>0.05)。结论神经阻滞添加佐剂,能带来较长时间的手术麻醉效果,也能为痛觉阈值低的患者带来较长时间的术后镇痛效果。使用常规剂量的佐剂具有较高的安全性,且出现的不良反应均在可接受和可控范围内。
Objective To observe the efficacy and safety evaluation of brachial plexus block combined with different commonly used adjuvants for the block.Methods A total of 110 patients,with ASA classification Ⅰ or Ⅱ,undergoing unilateral upper limb surgery,from June 2018 to June 2019,were selected from Honghu People's Hospital and randomized into 5 groups by random number table method,with 22 patients in each group.All patients underwent ultrasound-guided anesthesia for intermuscular sulcus and axillary brachial plexus block.Among them,group A is conventional local anesthetics(0.5% ropivacaine),group B is conventional local anesthetics mixed with 5 mg dexamethasone,group C is conventional local anesthetics mixed with 100 mg tramadol,group D is conventional local anesthesia mixed with 1/200000 adrenaline,and the group E was a conventional local anesthetic mixed with 1μg/kg dexmedetomidine.The onset time(T_(1))of the patient's nerve block,the duration of sensory block(T_(2))and the duration of motor block(T_(3))were recorded,and the patient's NRS pain score at 6 h,12 h,and 24 h after surgery,the scores and the occurrence of adverse reactions within 24 h after the operation of the 5 groups of patients were also recorded.Results Among the five groups of patients,the onset time of anesthesia and the duration of motor block were not significantly different among groups A,B,C,D,and E.The duration of sensory block in groups B,C,D,and E was significantly longer than that in group A,among which group C and group E were the longest,but there was no significant difference between the groups.After the adjuvant was added,there was no statistically significant difference in adverse reactions after anesthesia between the groups(P>0.05).Conclusion Adding adjuvants to nerve block can bring a longer period of surgical anesthesia,and it can also bring a longer period of postoperative analgesia for patients with low pain threshold.Adjuvants combined with conventional doses have high safety,and the adverse reactions are acceptable and manageable.
作者
方桥
陈庆红
王刚
周艳
张洋
刘涛
FANG Qiao;CHEN Qinghong;WANG Gang;ZHOU Yan;ZHANG Yang;LIU Tao(Department of Anesthesiology,Honghu People's Hospital,Honghu City,Honghu 433200;Department of Anesthesiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《麻醉安全与质控》
2021年第6期337-340,共4页
Perioperative Safety and Quality Assurance
基金
湖北省技术创新专项重大项目(2019ACA167)。
关键词
臂丛神经阻滞
佐剂
安全性评价
brachial plexus block
adjuvant
safety evaluation
