曹菁

【摘要】 目的 比較地佐辛復(fù)合不同濃度左布比卡因在臂叢神經(jīng)阻滯中的效果， 探討合適的麻醉方法。方法 80例行上肢手術(shù)患者， 采用隨機(jī)雙盲分為觀察組和對(duì)照組， 各40例。兩組患者均常規(guī)臂叢神經(jīng)阻滯準(zhǔn)備， 觀察組患者應(yīng)用0.25%左布比卡因30 ml+地佐辛2 mg；對(duì)照組患者應(yīng)用0.375%左布比卡因30 ml+地佐辛2 mg。觀察比較兩組患者的疼痛視覺(jué)模擬評(píng)分法（VAS）評(píng)分、麻醉效果、麻醉滿意程度及藥物不良反應(yīng)。結(jié)果 觀察組患者的VAS評(píng)分為（3.08±0.32）分， 低于對(duì)照組的（4.18±0.45）分， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患者的感覺(jué)阻滯起效時(shí)間（3.74±1.23）min、痛覺(jué)消失時(shí)間（14.27±4.34）min、運(yùn)動(dòng)阻滯起效時(shí)間（8.34±2.25）min， 均短于對(duì)照組的（5.02±1.40）、（18.34±5.22）、（12.23±3.30）min， 差異均具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患者的運(yùn)動(dòng)阻滯持續(xù)時(shí)間為（136.78±22.75）min， 長(zhǎng)于對(duì)照組的（113.27±15.34）min， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組患者中麻醉滿意38例（95.00%）高于對(duì)照組的32例（80.00%）， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者的藥物不良反應(yīng)發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（7.50% VS 10.00%， P>0.05）。兩組患者麻醉期間及麻醉后生命體征均穩(wěn)定， 所有患者無(wú)局麻藥中毒反應(yīng)、膈神經(jīng)或喉返神經(jīng)阻滯等發(fā)生。結(jié)論 0.375%左布比卡因和0.25%左布比卡因配伍地佐辛用于肌間溝臂叢神經(jīng)阻滯， 均獲得滿意的效果， 且隨著左布比卡因藥物濃度的增加， 運(yùn)動(dòng)阻滯程度的增加， 產(chǎn)生更強(qiáng)的鎮(zhèn)痛效果， 值得臨床應(yīng)用。

【關(guān)鍵詞】 地佐辛；左布比卡因；濃度；臂叢神經(jīng)阻滯

DOI：10.14163/j.cnki.11-5547/r.2016.36.010

【Abstract】 Objective To compare effects by dezocine combined with different concentrations of levobupivacaine in brachial plexus nerve block， and to investigate appropriate measure in anesthesia. Methods A total of 80 patients receiving upper limb surgery were divided by randomized double-blind method into observation group and control group， with 40 cases in each group. Both groups received conventional preparation for brachial plexus nerve block. The observation group received 30 ml of 0.25% levobupivacaine + 2 mg of dezocine. The control group received 30 ml of 0.375% levobupivacaine + 2 mg of dezocine. Observation was made on visual analogue scale （VAS） score， anesthetic effect， anesthetic satisfaction and adverse drug reactions between the two groups. Results The observation group had lower VAS score as （3.08±0.32） points than （4.18±0.45） points in the control group， and the difference had statistical significance （P<0.05）. The observation group had feeling block beginning time as （3.74±1.23） min， pain disappearance time as （14.27±4.34） min， and motor block beginning time as （8.34±2.25） min， which were all shorter than （5.02±1.40）， （18.34±5.22） and （12.23±3.30） min in the control group， and their differences all had statistical significance （P<0.05）. The observation group had more anesthetic satisfaction cases as 38 cases （95.00%） than 32 cases （80.00%） in the control group， and the difference had statistical significance （P<0.05）. There was no statistically significant difference of incidence of adverse reactions between the two groups （7.50% VS 10.00%， P>0.05）. Both groups had stable vital signs during and after anesthesia， and there was no local anesthesia drug poisoning reactions， phrenic nerve block or recurrent laryngeal nerve block in any case. Conclusion Both of 0.375% levobupivacaine and 0.25% levobupivacaine， combining with dezocine， provide satisfactory effects in interscalene brachial plexus nerve block. Increasing in concentration of levobupivacaine leads to enhanced motor block degree and intensified analgesic effect. This method is worth clinical application.