地佐辛復合不同濃度左布比卡因在臂叢神經阻滯中的效果觀察

曹菁

【摘要】 目的 比較地佐辛復合不同濃度左布比卡因在臂叢神經阻滯中的效果， 探討合適的麻醉方法。方法 80例行上肢手術患者， 采用隨機雙盲分為觀察組和對照組， 各40例。兩組患者均常規臂叢神經阻滯準備， 觀察組患者應用0.25%左布比卡因30 ml+地佐辛2 mg；對照組患者應用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模擬評分法（VAS）評分、麻醉效果、麻醉滿意程度及藥物不良反應。結果 觀察組患者的VAS評分為（3.08±0.32）分， 低于對照組的（4.18±0.45）分， 差異具有統計學意義（P<0.05）。觀察組患者的感覺阻滯起效時間（3.74±1.23）min、痛覺消失時間（14.27±4.34）min、運動阻滯起效時間（8.34±2.25）min， 均短于對照組的（5.02±1.40）、（18.34±5.22）、（12.23±3.30）min， 差異均具有統計學意義（P<0.05）。觀察組患者的運動阻滯持續時間為（136.78±22.75）min， 長于對照組的（113.27±15.34）min， 差異具有統計學意義（P<0.05）。觀察組患者中麻醉滿意38例（95.00%）高于對照組的32例（80.00%）， 差異具有統計學意義（P<0.05）。兩組患者的藥物不良反應發生率比較差異無統計學意義（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定， 所有患者無局麻藥中毒反應、膈神經或喉返神經阻滯等發生。結論 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， 運動阻滯程度的增加， 產生更強的鎮痛效果， 值得臨床應用。

【關鍵詞】 地佐辛；左布比卡因；濃度；臂叢神經阻滯

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.