摘要
目的通过观察0．250％、0．375％、0．500％、0．750％的罗哌卡因在临床应用的效果，以期寻找罗哌卡因在肌间沟臂丛阻滞中的最佳用药浓度。方法120例随机分成四组：罗哌卡因0．250％、0．375％、0．500％、0．750％分别为Ⅰ、Ⅱ、Ⅲ、Ⅳ组各30例，罗哌卡因用量均为20ml。观察各组起效时间，维持时间，感觉阻滞效果，肌肉松弛阻滞效果，术中呼吸、血压、动态心电图等改变。结果在感觉阻滞效果上，Ⅰ组与其他组比较差异有统计学意义（P〈0．05）。Ⅱ、Ⅲ、Ⅳ组间比较差异无统计学意义。即罗哌卡因浓度≥0．375％产生感觉阻滞效果差异无统计学意义。肌肉松弛阻滞效果及维持时间方面比较：Ⅰ、Ⅱ组比较及Ⅲ、Ⅳ组比较差异均无统计学意义，Ⅰ、Ⅱ组与Ⅲ、Ⅳ组比较差异则有统计学意义（P〈0．05）。即罗哌卡因在肌间沟臂丛阻滞麻醉中产生较好的肌肉松弛效果其浓度须≥0．500％，且Ⅲ、Ⅳ组维持时间与Ⅰ、Ⅱ组比较明显延长（P〈0．01）。起效时间各组间比较差异无统计学意义。术中监护中，未发现心律失常及药物不良反应。结论罗哌卡因在肌间沟臂丛阻滞麻醉中是能较安全使用的局部麻醉药，有不能依靠提高浓度缩短麻醉起效时间的特性，其最佳使用浓度是0．375％-0．500％。低于0．375％的浓度影响肌间沟臂丛阻滞麻醉效果，超过0．500％浓度的罗哌卡因在臂丛阻滞麻醉中并无增强作用。
Objective To respectively observe the clinical effect of different concentration ropivacaine in intergroove brachial plexus block, and evaluate the proper concentration of ropivacaine. Methods Four groups were established randomly in 120 patients （n = 30 per group ）, 20 ml of 0. 250%, 0. 375% , 0. 500%, 0. 750% ropivacaine was given to the patients in group Ⅰ , Ⅱ, Ⅲ, Ⅳ respectively, observed each group＇s onset time, maintenance time, the effect of sensory block and muscular relaxant, the change of blood pressure, respiratory rate and ambulatory ECG during anesthesia. Results There was distinct difference between the effect of sensory block in group Ⅰ and that in the other groups （P 〈 0.05 ）, and there was no distinct difference between group Ⅱ , Ⅲ, Ⅳ. The effect of muscular relaxant and maintenance time in group Ⅰ , Ⅱwere differ markedly with those in group Ⅲ, Ⅳ（P 〈 0.05 ）. The maintenance time was longer in group Ⅲ, Ⅳ than that in group Ⅰ , Ⅱ（P 〈 0.01 ）. There was no effective rate difference at onset time between the four groups. No arrhythmia or side effects of ropivacaine occurred during anesthesia. Conclusions Ropivacaine can be safely administrated in intergroove brachial plexus block anesthesia, but the onset time can not be reduced by increasing the concentration of ropivacaine, the proper concentration is 0.375% - 0.500%, when the concentration is less than 0.375%, the effect of ropivacaine in intergroove brachial plexus block will be weakened, and the effect will not be strengthened when the concentration is raised above 0.500%.
出处
《中国医师进修杂志》
2007年第6期14-16,共3页
Chinese Journal of Postgraduates of Medicine
