本文選題：超聲 + 羅哌卡因�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的： 研究探討不同劑量0.5%羅哌卡因在超聲引導(dǎo)下腋路臂叢神經(jīng)阻滯中的效果，并探尋劑量對(duì)上臂神經(jīng)支配效果的影響，以期尋找羅哌卡因在腋路臂叢神經(jīng)阻滯中的合理劑量。 方法： 選擇符合條件的上肢手術(shù)患者75例，年齡16-70歲，體重40-90kg，ASA I-II級(jí)，將患者隨機(jī)分為A、B、C三組，每組25例，其中局麻藥劑量為A組20ml，B組30ml，C組40ml，均采用0.5%羅哌卡因，在超聲引導(dǎo)下行腋路臂叢神經(jīng)阻滯。采用一針?biāo)狞c(diǎn)方法將局麻藥分別送至肌皮神經(jīng)，橈神經(jīng)，正中神經(jīng)，尺神經(jīng)周圍。其中每個(gè)靶點(diǎn)藥物劑量為該組局麻藥總量的四分之一。記錄阻滯操作時(shí)間，于注藥完畢后30min內(nèi)每隔五分鐘記錄臂叢各分支神經(jīng)支配區(qū)域感覺及運(yùn)動(dòng)阻滯起效時(shí)間（感覺神經(jīng)阻滯效果評(píng)估采用針刺法，運(yùn)動(dòng)神經(jīng)阻滯效果評(píng)估采用改良Bromage分級(jí)），并評(píng)定手術(shù)過(guò)程中的麻醉效果（優(yōu)、中、差），隨訪記錄阻滯維持時(shí)長(zhǎng)及術(shù)中、后各種并發(fā)癥。 結(jié)果： 各組神經(jīng)阻滯操作時(shí)間無(wú)統(tǒng)計(jì)學(xué)差異（P0.05），臂叢各神經(jīng)分支阻滯有效率接近100%，麻醉效果優(yōu)等率各組間比較無(wú)統(tǒng)計(jì)學(xué)差異（P0.05），臂外側(cè)上皮神經(jīng)，臂內(nèi)側(cè)皮神經(jīng)及前臂內(nèi)側(cè)皮神經(jīng)阻滯起效時(shí)間A組明顯長(zhǎng)于C組（P 0.05），尺神經(jīng)運(yùn)動(dòng)阻滯起效時(shí)間B組明顯長(zhǎng)于C組，有統(tǒng)計(jì)學(xué)差異（P 0.05）。A、B、C各組上臂皮支間臂外側(cè)上皮神經(jīng)阻滯起效時(shí)間均明顯長(zhǎng)于臂外側(cè)下皮神經(jīng)，臂后側(cè)皮神經(jīng)及臂內(nèi)側(cè)皮神經(jīng)（P 0.01），各組內(nèi)腋神經(jīng)運(yùn)動(dòng)阻滯起效時(shí)間明顯長(zhǎng)于其余運(yùn)動(dòng)神經(jīng)阻滯起效時(shí)間（P 0.05）。阻滯維持時(shí)間A組，顯著短于B、C兩組，差異有統(tǒng)計(jì)學(xué)意義（P 0.05），A，B，C三組之間惡心嘔吐發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。C組女性惡心嘔吐的發(fā)生率明顯大于男性（P 0.05）。各組未見神經(jīng)損傷等其他并發(fā)癥，且無(wú)一例需改全麻。 結(jié)論： 超聲引導(dǎo)腋路臂叢阻滯可達(dá)到很完善的阻滯效果，基本依靠單一的麻醉方法完成大部分上肢手術(shù)，，同時(shí)能保證病人術(shù)中的無(wú)痛；阻滯中局麻藥用量越大，起效相對(duì)越快，阻滯維持時(shí)間越長(zhǎng)，上臂感覺及運(yùn)動(dòng)的阻滯效果越好，但并發(fā)癥發(fā)生率有一定增加；綜合考慮起效時(shí)間、阻滯效果及并發(fā)癥，30ml局麻藥量可能是較好的選擇。
[Abstract]:Objective: To study the effect of different doses of ropivacaine in axillary brachial plexus block guided by ultrasound, and to explore the effect of dose on the innervation of upper brachial plexus, in order to find out the reasonable dose of ropivacaine in axillary brachial plexus block. Methods: 75 patients, aged 16-70 years and weighing 40-90 kg / I-II, were randomly divided into three groups: group A (n = 25), group A (n = 25), and group A (n = 25) with local anesthetic dosage of group A (n = 20), group B (n = 30), group C (n = 40), and group C (n = 40) with 0.5% ropivacaine. Axillary brachial plexus block was guided by ultrasound. The local anesthetic was delivered to the musculocutaneous nerve, radial nerve, median nerve and ulnar nerve by a four point method. The dose of each target drug was 1/4 of the total amount of local anesthetics in the group. The operation time of block was recorded, and the onset time of sensory and motor block in the innervation region of brachial plexus was recorded every five minutes in 30min. The effect of motor nerve block was evaluated by modified Bromage classification. The anesthetic effect during operation was evaluated (excellent, moderate and poor). The duration of block and complications during operation were recorded. Results: There was no statistical difference in the operation time of nerve block in each group (P 0.05), the effective rate of nerve branch block in brachial plexus was close to 100, there was no significant difference in the excellent anaesthesia effect among groups (P 0.05). The onset time of medial brachial cutaneous nerve and medial forearm cutaneous nerve block in group A was significantly longer than that in group C (P 0.05), and the onset time of motor block of ulnar nerve in group B was significantly longer than that in group C. There were significant differences in the onset time of the upper arm cutaneous branch interbrachial lateral epithelial nerve block between the upper arm and the lower arm cutaneous nerve. The onset time of motor block of axillary nerve in each group was significantly longer than that of other motor nerve block (P 0.05). The duration of block maintenance in group A was significantly shorter than that in group B (P 0.05). There was no significant difference in the incidence of nausea and vomiting among the three groups (P 0.05). The incidence of nausea and vomiting in group C was significantly higher than that in group C (P 0.05), and the incidence of nausea and vomiting in group C was significantly higher than that in group C (P 0.05). There were no other complications such as nerve injury in each group, and none of them needed general anesthesia. Conclusion: Ultrasound-guided axillary brachial plexus block can achieve a very perfect block effect, basically rely on a single anesthesia method to complete most of the upper limb surgery, at the same time can ensure that the patient during the operation painless, the larger the amount of local anesthetic in block, the faster the effect is. The longer the duration of block, the better the effect of sensory and motor block on upper arm, but the incidence of complications was increased. Considering the time of onset, the effect of block and the dosage of 30 ml local anesthetic may be the better choice.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614;R445.1

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