相同浓度不同容量罗哌卡因超声引导锁骨上臂丛神经阻滞对膈肌麻痹的影响

摘要

目的 观察超声引导锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)使用相同浓度不同容量罗哌卡因对膈肌麻痹的影响.方法 选择拟行右上肢骨折术后取内固定装置术的患者72例,男32例,女40例,年龄18~65岁,ASA I或II级.随机分为两组:0.375%罗哌卡因20 ml组(A组)和0.375% 罗哌卡因30 ml(B组),每组36例.所有患者在超声引导下行锁骨上臂丛神经阻滞,记录臂丛各主要神经根的感觉阻滞、运动阻滞的起效时间和持续时间,并观察两组患者不良反应的发生情况.采用M型超声测量阻滞前、阻滞后30 min时两组平静呼吸和用力呼吸的膈肌移动度,通过观察膈肌移动度的变化来反映膈肌麻痹情况,并计算膈肌麻痹率.结果 两组患者感觉阻滞起效时间、感觉阻滞和运动阻滞持续时间差异均无统计学意义.B组运动阻滞起效时间明显短于A组(P<0.05).阻滞后30 min A组和B组分别有12例(33.3%)和22例(61.1%)患者出现膈肌麻痹,B组膈肌麻痹率明显高于A组(P<0.05).结论 0.375%罗哌卡因20 ml与30 ml在超声引导下行锁骨上臂丛神经阻滞均可达到理想的臂丛阻滞效果,0.375%罗哌卡因20 ml引起膈肌麻痹较少.%Objective To investigate the effects of different volumes of ropivacaine with the same solubility in supraclavicular brachial plexus block(SCBPB) under ultrasound guidance on ipsilateral diaphragmaticparalysis.Methods Seventy two patients (32 males,40 females, aged 18-65 years, of ASA Ⅰ or Ⅱ, scheduled for the right upper limb fracture internal fixation removal were randomized into group A (0.375% ropivacaine 20 ml) and group B (0.375% ropivacaine 30 ml), 36 cases in each group.The onset and duration of sensory and motor block were observed as well as complication.Diaphragmatic excursion were evaluated by M type ultrasound before and 30 min after drug injection under eupnea and forced respiration through observing diaphragmatic excursion to study diaphragmatic paralysis.Results The onset time of sensory block and maintaining time of sensory block or motor block had no significant difference between the two groups.Compared with group A,the onset time of motor block in group B was significantly shorter (P<0.05).Twelve cases (33.3%) in group A and 22 cases (61.1%) in group B respectively showed complete or partial hemidiaphragmatic paralysis 30 min after drug injection.Compared with group A, the rate of diaphragmatic paralysis in group B was significantly higher (P<0.05).Conclusion Supraclavicular brachial plexus block under ultrasound guidance with 0.375% ropivacaine 20 ml or 30 ml both can provide excellent anesthetic effect.0.375% ropivacaine 20 ml is less likely to lead to diaphragmatic paralysis.