芬太尼局部用药对罗哌卡因臂丛神经阻滞最低有效浓度的影响.pdf

浙江医学2016 年第38 卷第24 期 芬太尼局部用药对罗哌卡因臂丛 神经阻滞最低有效浓度的影响 汪昕 祝胜美 胡双飞 【摘要 】 目的 研究芬太尼局部用药对罗哌卡因臂丛神经阻滞最低有效浓度的影响。方法 将 100 例择期手术患者按随机 数字表法分为罗哌卡因组（R 组）和罗哌卡因复合芬太尼组（RF 组），各50 例。两组患者均在超声引导下行锁骨上臂丛神经阻滞，R 组 注射30ml 的罗哌卡因，RF 组注射罗哌卡因与0.05mg 芬太尼混合液，罗哌卡因以0.30%为起始浓度，采用序贯法，相邻浓度比值为 1.2。注药后30min 内通过视觉模拟法评分（VAS ）评定麻醉是否有效，同时记录围麻醉期相关并发症。采用Dixon-Massey 法计算 罗哌卡因的半数有效浓度（EC ）及其95%可信区间（95%CI ）。结果 R 组与RF 组罗哌卡因EC （95%CI ）分别为0.25 1%（0.231%~ 50 50 0.274% ）和0.219%（0.198%~0.245% ）。与R 组比较，RF 组罗哌卡因EC50 降低，降低幅度为 13%。结论 B 超引导下复合小剂量芬 太尼可显著强化罗哌卡因锁骨上臂丛神经阻滞的效果。 【关键词】 芬太尼 罗哌卡因 神经传导阻滞 最低有效浓度 Local administration of fentanyl enhances effect of ropivacaine in brachial plexus block anesthesia China 【Abstract 】 Objective To investigate the effects of local administration of fentanyl on the minimal effective concentration of ropivacaine for brachial plexus block anesthesia. Methods One hundred patients were randomly divided into ropivacaine group (group R) and ropivacaine combined with fentanyl group (group RF) with 50 cases in each. The ultrasound-guided supraclavicular brachial plexus block was performed in both groups, 30ml ropivacaine was injected in group R and ropivacaine with 0.05mg fentanyl mixture was injected in group RF. In group RF the initial concentration of ropivacaine was 0.30%, tested by Up Down sequential method with the adjacent concentration ratio of 1.2. The effectiveness was assessed by visual analogue scale (VAS) in 30 min after injection, and the related complications were recorded. The half effective concentration (EC ) and 50 95%CI were calculated by Dixon-Massey method. Results There were no significant differences in gender ratio, age and BMI between two groups. The EC50 of ropivacaine in group R and group RF were 0.251%(95%CI:0.231%-0.274%) and 0.219% (95% CI