摘要
目的：观察地塞米松联合地佐辛用于超声引导下肌间沟臂丛神经阻滞的临床效果。方法选择美国麻醉医师协会麻醉（ASA）分级Ⅰ～Ⅱ级骨科上肢手术患者80例，按照随机数字表法分为四组，每组各20例。A 组0．45％甲磺酸罗哌卡因20 mL；B 组0．45％甲磺酸罗哌卡因＋地塞米松0．1 mg／kg 共20 mL；C 组0．45％甲磺酸罗哌卡因＋地佐辛0．1 mg／kg 共20 mL；D 组0．45％甲磺酸罗哌卡因＋地塞米松0．1 mg／kg ＋地佐辛0．1 mg／kg 共20 mL。分别记录四组患者的麻醉起效时间，阻滞完善时间，镇痛持续时间，以及术后不良反应的发生情况。结果 C 组、D 组麻醉起效时间快于 A 组、B 组[C 组（3．65±0．88）min 比 A 组（5．60±0．88）min、B 组（5．35±0．81）min，t ＝7．303、6．367，均 P ＝0．000；D 组（3．30±0．80）min 比 A 组、B 组，t ＝8．614、7．678，均 P ＝0．000]，C 组、D 组阻滞完善时间快于 A 组、B 组[C 组（8．45±1．19）min 比 A 组（12．75±2．05）min、B 组（12．65±1．90）min，t ＝8．583、8．383，均 P ＝0．000；D 组（7．80±0．89）min 比 A 组、B 组，t ＝9．880、9．680，均 P ＝0．000]，镇痛持续时间各组均长于 A 组[B 组（430．50±30．86）min、C 组（435．00±38．46）min、D 组（534．50±46．73）min 比 A 组（314．50±33．32）min，t ＝9．696、10．072、18．388，均 P ＝0．000]， D 组最佳（D 组比 B 组、C 组，t ＝8．693、8．317，均 P ＝0．000），B 组 C 组之间差异无统计学意义（C 组比 B 组， t ＝0．376，P ＝0．708）。80例患者中仅 C 组有1例出现术后恶心呕吐的症状，各组间差异均无统计学意义（均P ＞0．05）。结论地塞米松联合地佐辛用于超声引导下肌间沟臂丛神经阻滞缩短了麻醉起效时间和阻滞完善时间，延长了镇痛持续时间，术后不良反应少，麻醉效果更好，更适合应用于骨科上肢手术患者的麻醉。
Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ -Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group：group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C（3.65 ±0.88）min vs.group A（5.60 ±0.88）min,group B（5.35 ±0.81）min,t =7.303, 6.367,all P =0.000;group D（3.30 ±0.80）min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C（8.45 ±1.19）min vs. group A（12.75 ±2.05）min,group B（12.65 ±1.90）min,t =8.583,8.383,all P =0.000;group D（7.80 ±0.89）min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B（430.50 ±30.86）min,group C（435.00 ±38.46）min,group D（534.50 ±46.73）min vs. group A（314.50 ±33.32）min,t =9.696,10.072,18.388,all P =0.000],group D was the best（group D vs.group B,group C,t =8.693,8.317,all P =0.000）,there were no significant differences between group B and group C （group C vs.group B,t =0.376,P =0.708）.In the 80 patients,only one case of group C had postoperative nauseanbsp;and vomiting symptoms,there were no significant differences between the groups（all P 〉0.05）.Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.
作者
李宗师
康志宇
Li Zongshi Kang Zhiyu(Department of Anesthesiology, the Capital Medical University of Continuing Education in General Medicine, Yanqing District Hospital, Beijing 102100, China)
出处
《中国基层医药》
CAS
2016年第21期3329-3332,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
神经肌肉阻滞
臂丛
超声检查
地塞米松
地佐辛
Neuromuscular blockade
Brachial plexus
Ultrasonography
Dexamethasone
Dezocine
