摘要
目的 比较长效局麻药罗比卡因应用于单侧腰丛 坐骨神经联合阻滞和硬膜外麻醉时临床麻醉起效和恢复时间、术后镇痛效果及对血液动力学的影响。方法 34例临床拟行单侧下肢手术的病人 ,随机分为腰丛 坐骨神经联合阻滞 (NER ,n =17)和硬膜外麻醉 (EPI,n =17)两组 ,分别施行单侧腰丛复合坐骨神经阻滞和硬膜外麻醉。NER组腰丛和坐骨神经阻滞采用神经刺激器定位技术 ,刺激器电流频率 2Hz,起始强度 1～ 2mA ,正确定位后两点分别给予 0 5 %罗比卡因 2 0～ 30ml;EPI组则选择L2～ 3 或L3～ 4间隙行硬膜外麻醉 ,予 0 75 %罗比卡因 15～ 2 0ml。记录麻醉前 ,手术开始 ,手术开始后 15、30、45、6 0分钟 ,术后 1小时的收缩压 (SBP)、舒张压 (DBP)和心率 (HR) ,以及感觉、运动神经阻滞起效及恢复时间、镇痛维持时间及效果 (术后 1、4小时VAS评分 )、局麻药和辅助药物用量、术中输液量、药物不良反应等指标。结果 手术开始后 15分钟 ,EPI组病人DBP降低明显 (P <0 0 5 ) ,随后 30、45、6 0分钟及术后 1小时EPI组病人的SBP、DBP均明显低于NER组 ;NER组感觉、运动神经阻滞起效时间均小于EPI组 (P <0 0 5 ) ,EPI组感觉神经、运动神经恢复较NER组快 (P <0 0 5 ) ;NER组罗比卡因平均用量大于EPI组 (P <0 0 5 )。NER?
Objective To evaluate the onset time and duration,postoperative analgesia,and the hemodynamic responses of peripheral nerve block and epidural anesthesia with ropivacaine in the thirty-four patients undergoing lower-extremity surgery.Methods Thirty-four patients, ASA physical status of Ⅰ-Ⅲ,undergoing lower-extremity surgery were randomly allocated into two groups:NER (n=17) and EPI (n=17).In group NER, combined lumber plexus-sciatic nerve block was performed directed by a nerve stimulator (2Hz of stimulation frequency and 0-5mA of currency).Subsequently,0.5% ropivacaine 20-30ml was injected in devided doses.In group EPI,epidural anesthesia was performed at L 2-3 or L 3-4 interspace with 0.75% ropivacaine 15-20ml.The systolic and diastolic blood pressure,and heart rate were measured before anesthesia,at the beginning of surgery,15,30,45 and 60 min after the incision of surgery,and 1h after completion of operation.The onset time,duration of sensory and motor block,the duration and quality of postoperative analgesia (VAS scores at 1,4h postoperatively),and side effects were recorded at the same tine points.Results The diastolic blood pressure was decreased more significantly in group EPI than that in group NER at 15min after the beginning of the surgery (P<0.05).So were the diastolic and systolic pressures at 30,45 and 60 min during operation,and 1h after surgery (P<0.05).The onset of sensory and motor blockade was significantly faster and the recovery slower in group NER than those in group EPI (P<0.05).Duration of postoperative analgesia was significantly longer in group NER than that in group EPI (P<0.05).Conclusion By means of a nerve stimulator,ropivacaine is a good choice for peripheral nerve block with a rapid onset,a long duration of analgesia and a stable hemodynamics.
出处
《临床麻醉学杂志》
CAS
CSCD
2002年第5期235-238,共4页
Journal of Clinical Anesthesiology
