氢吗啡酮对罗哌卡因臂丛神经阻滞 临床效果的影响

Effect of Hydromorphone on brachial plexus block with Ropivacaine

摘要:

目的 观察氢吗啡酮对罗哌卡因臂丛神经阻滞效果的影响。方法 选取该院臂丛神经阻滞下行上臂 骨折手术患者60 例，随机分为Ⅰ组和Ⅱ组，每组各30 例。Ⅰ组使用0.375% 罗哌卡因20 ml，Ⅱ组在Ⅰ组基础上 加入4 μg/kg 氢吗啡酮；分别记录臂丛神经阻滞起效时间和镇痛维持时间。采用视觉模拟评分（VAS）评价术 后9 h（T1）、12 h（T2）、15 h（T3）镇痛效果及术后静脉自控镇痛泵（PCIA）中镇痛药的用量；观察两组术中和 术后不良反应发生情况。结果 Ⅰ组神经阻滞起效时间长于Ⅱ组，但镇痛维持时间短于Ⅱ组（P <0.05）；Ⅰ组各时 间的静息VAS 评分高于Ⅱ组，PCIA 使用总量高于Ⅱ组（P <0.05）；两组术中、术后均未出现不良反应。结论 氢 吗啡酮可增强罗哌卡因臂丛神经阻滞麻醉效果，在上肢骨折手术中值得推广。

Abstract:

Objective To evaluate the effect of Hydromorphone on brachial plexus block with Ropivacaine. Methods Sixty patients undergoing upper arm fracture surgery were randomly divided into two groups with 30 patients for each one. Patients received brachial plexus block with 0.375% Ropivacaine (group Ⅰ ) or 0.375% Ropivacaine combined with 4 μg/kg Hydromorphone (group Ⅱ ). The onset time and the duration of anesthesia were recorded. Viaual Analog Scale (VAS) and the dosage of the analgesic pump of both groups were recorded 9, 12 and 15 hours after the operation. The side effect was also observed in the study. Results Compared with group Ⅰ , the onset time of anesthesia was shorter and the duration of anesthesia was longer in group Ⅱ (P < 0.05). The postoperative VAS was lower in group Ⅱ (P < 0.05), and the dosage of the analgesic pump was fewer in group Ⅱ (P < 0.05). There was no significant difference in the incidence of side effects in both groups. Conclusions Hydromorphone can increase the effect of brachial plexus block with Ropivacaine, and this is a safe and effective method for promotion.