【摘要】：目的： 評價甲磺酸羅哌卡因、甲磺酸羅哌卡因和曲馬多兩藥聯(lián)合應用的安全性和有效性，為臨床提供合理、安全、滿意的麻醉效果。 方法： 選擇2013年12月－2014年8月沈陽醫(yī)學院附屬中心醫(yī)院麻醉科34例行擇期上肢手術(shù)患者，ASA分級I~II級，年齡18-50歲，體重45-90kg，患者無臂叢神經(jīng)阻滯的禁忌癥。將病人隨機分成2組（A組18例，B組16例），A組：0.596%甲磺酸羅哌卡因40ml，B組：0.596%甲磺酸羅哌卡因，曲馬多100mg共40ml，兩組進行同樣的麻醉操作，比較兩組觀察指標的變化。 結(jié)果： 兩組病例的性別、年齡、體重經(jīng)統(tǒng)計學分析均無統(tǒng)計學意義。麻醉前、后生命體征（BP、HR、SpO2、SBP）無統(tǒng)計學意義（P0.05），兩組DBP在麻醉20分時的差異有統(tǒng)計學意義(P0.05)，其他時刻均無統(tǒng)計學意義。兩組的BP和SpO2組間比較無統(tǒng)計學意義（P0.05），，心率的組間比較有統(tǒng)計學意義(P0.05)。B組感覺阻滯起效時間（1.94±0.77）min，A組感覺阻滯起效時間（4.22±1.70）min，組間比較差異有統(tǒng)計學意義(P0.001)，B組感覺阻滯起效時間較短。B組運動阻滯起效時間（3.69±0.95）min，A組運動阻滯起效時間（7.00±2.40）min，組間比較差異有統(tǒng)計學意義(P0.001)，B組運動阻滯起效時間較短。 結(jié)論: 1.不同時間點單獨使用甲磺酸羅哌卡因與聯(lián)合使用甲磺酸羅哌卡因、曲馬多兩組在進行腋路臂叢神經(jīng)阻滯麻醉過程中，血壓、心率、血氧飽和度的變化均無差異，說明麻醉過程中是安全的。 2.單獨使用甲磺酸羅哌卡因，聯(lián)合使用甲磺酸羅哌卡因、曲馬多進行腋路臂叢神經(jīng)阻滯麻醉時，血壓和血氧飽和度組間無差異。 3.單獨使用甲磺酸羅哌卡因進行腋路臂叢神經(jīng)阻滯麻醉時不同時間心率均高于聯(lián)合使用甲磺酸羅哌卡因、曲馬多進行腋路臂叢神經(jīng)阻滯麻醉時心率； 4.單獨使用甲磺酸羅哌卡因進行腋路臂叢神經(jīng)阻滯麻醉感覺阻滯起效時間和運動阻滯起效時間均顯著高于聯(lián)合使用甲磺酸羅哌卡因、曲馬多。
[Abstract]:Objective: to evaluate the safety and efficacy of ropivacaine mesylate, ropivacaine mesylate and tramadol in clinical anesthesia. Methods: from December 2013 to August 2014, 34 patients in Department of Anesthesiology, affiliated Hospital of Shenyang Medical College, with ASA grade I~II, aged 18-50 years, weight 45-90 kg, had no contraindication of brachial plexus block. Patients were randomly divided into two groups: group A (n = 18), group B (n = 16), A: 0.596% ropivacaine mesylate (n = 16): group B: 0.596% ropivacaine mesylate (n = 20) and tramadol 100mg (n = 40). The changes of observation indexes were compared between the two groups. Results: there was no significant difference in sex, age and body weight between the two groups. Before anesthesia, after the vital signs (BP,HR,SpO2,SBP) had no statistical significance (P0.05), the two groups of DBP in anesthesia at 20 hours of the difference was statistically significant (P0.05), no statistical significance at other times. There was no significant difference in BP and SpO2 between the two groups (P0.05), but there was significant difference in heart rate (P0.05) in the). B group (P0.05) the onset time of sensory block was (1.94 鹵0.77) min,. The onset time of sensory block in group A was (4.22 鹵1.70) min, the onset time of sensory block in group B was (3.69 鹵0.95) min, that of group B was (3.69 鹵0.95) min,. The onset time of motor block in group A was (7. 00 鹵2. 40) min, (P 0. 001), B). The onset time of motor block in group A was shorter than that in group A (P 0. 001 鹵2. 40). Conclusion: 1. There was no difference in blood pressure, heart rate and oxygen saturation between tramadol group and ropivacaine mesylate group during axillary brachial plexus block anesthesia at different time points. It shows that it is safe during anesthesia. 2. When ropivacaine mesylate was used alone, ropivacaine mesylate combined with tramadol for axillary brachial plexus block, there was no difference between blood pressure and oxygen saturation. 3. The heart rate of ropivacaine mesylate alone in axillary brachial plexus block anesthesia was higher than that of combined ropivacaine mesylate group and tramadol in axillary brachial plexus block anesthesia. 4. The onset time of sensory block and motor block in axillary brachial plexus block with ropivacaine mesylate alone was significantly higher than that with ropivacaine mesylate and tramadol.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614.4

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