摘要
目的观察静脉应用地塞米松和布托啡诺两种药物对超声引导下0.5%罗哌卡因腋路臂丛神经阻滞麻醉效果的影响。方法选取2020年11月至2021年6月在该院行手部手术拟采用腋路臂丛神经阻滞的患者60例,采用随机数字表法将其分为D、B组,每组30例。在臂丛神经阻滞前5 min,D组开始输注地塞米松(负荷量8 mg+维持量1 mg/h,安全用药剂量的极限设定为13 mg),B组给予布托啡诺(负荷量0.8 mg+维持量0.2 mg/h,极量设定为1.8 mg),随后两组患者均在超声引导下应用0.5%罗哌卡因40 mL进行腋路臂丛神经阻滞。记录两组手术时间,麻醉起效时间,痛觉和运动阻滞维持时间,神经阻滞后4、6、8、10、12、24 h疼痛程度视觉模拟评分法(VAS)评分及手部运动能力运动神经阻滞评分(MBS),阻滞成功率,麻醉后24 h内休息受干扰程度评分及不良反应发生率。结果D组与B组相比,麻醉起效时间更短[12.00(9.00,18.00)min vs.16.50(13.50,18.75)min],痛觉阻滞维持时间更长[1025.50(825.50,1274.50)min vs.685.50(592.00,840.50)min],运动阻滞维持时间更长[903.00(762.75,1115.25)min vs.623.50(557.75,931.25)min],麻醉后24 h内休息受干扰程度更小[0.50(0.50,0.50)分vs.1.75(0.50,6.00)分],差异均有统计学意义(P<0.05);B、D两组在阻滞成功率及不良反应发生率方面比较,差异均无统计学意义(P>0.05)。D组患者阻滞后12、24 h疼痛程度(VAS评分)小于B组,差异均有统计学意义(P<0.05)。两组患者麻醉后10、12 h手部运动能力MBS比较,差异均有统计学意义(P<0.05),但麻醉后24 h时,两组患者手部运动能力MBS比较,差异无统计学意义(P>0.05)。结论与布托啡诺相比,静脉应用地塞米松对超声引导下0.5%罗哌卡因腋路臂丛神经阻滞麻醉辅助效果更强。
Objective To observe the influence of the intravenous application of dexamethasone and butorphanol on ultrasound-guided axillary brachial plexus block anestihesia with 0.5%ropivacaine.Methods A total of 60 patients with axillary brachial plexus block who underwent hand surgery in this hospital from November 2020 to June 2021 were randomly divided into group D and group B,with 30 patients in each group.Five minutes before nerve block,patients in group D began to receive dexamethasone(load 8 mg+maintenance 1 mg/h,the maximum dose was 13 mg),and patients in group B began to receive butorphanol(load 0.8 mg+maintenance 0.2 mg/h,the maximum dose was 1.8 mg),then the two groups received ultrasound-guided axillary brachial plexus block with 0.5%ropivacaine 40 mL.The surgery time,sensory block onset time,the duration time of sensory block and motor block,the score of visual analogue scale(VAS),Motor block score(MBS)(at the time of 4,6,8,10,12,24 h after nerve block),successful block rate,the score of rest disturbance degree and adverse reaction incidence within 24 h after nerve block were recorded.Results Compared with group B,group D had a shorter onset time[12.00(9.00,18.00)min vs.16.50(13.50,18.75)min],a longer duration time of sensory block[1025.50(825.50,1274.50)min vs.685.50(592.00,840.50)min]and motor block[903.00(762.75,1115.25)min vs.623.50(557.75,931.25)min],a lower score of rest disturbance degree within 24 h after nerve block[0.50(0.50,0.50)points vs.1.75(0.50,6.00)points],the differences were statistically significant(P<0.05).There was no statistical difference in the aspects of success block rate and adverse reaction incidence between two groups(P>0.05).The pain degree(VAS score)at 12 h and 24 h after anesthesia in group D was less than those in group B,and the differences were statistically significant(P<0.05).The comparison of MBS of hand motor ability between the two groups at 10 h and 12 h after anesthesia showed a statistically significant difference(P<0.05).However,there was no significant difference in MBS of hand motor ability between the two groups at 24 h after anesthesia(P>0.05).Conclusion Compared with butorphanol,the intravenous application of dexamethasone produces a stronger assistant influence for ultrasound-guided 0.5%ropivacaine axillary brachial plexus block anesthesia.
作者
刘城
王宇恒
李闯
LIU Cheng;WANG Yuheng;LI Chuang(Department of Anesthesia,the Affiliated Central Hospital of Shenyang Medical College,Shenyang,Liaoning 110000,China)
出处
《现代医药卫生》
2022年第6期943-947,共5页
Journal of Modern Medicine & Health
关键词
地塞米松
布托啡诺
罗哌卡因
超声引导
腋路
臂丛神经阻滞
Dexamethasone
Butorphanol
Ropivacaine
Ultrasound-guided
Axillary
Brachial plexus block
