不同剂量地塞米松对罗哌卡因神经阻滞作用影响.doc.docVIP

不同剂量地塞米松对罗哌卡因神经阻滞作用的影 张大志1 王东信2 王怀江1 【摘要】　目的　比较不同剂量地塞米松复合罗哌卡因神经阻滞对罗哌卡因阻滞时效的影响。方法 60例患者随机分为I、II、III三组，每组20例。所有患者均在神经刺激器定位下行坐骨神经复合腰丛阻滞麻醉。I组：1%罗哌卡因20ml加入生理盐水30ml；II组：1%罗哌卡因20ml加入地塞米松5mg、生理盐水29ml；III组：1%罗哌卡因20ml加入地塞米松10mg、生理盐水28ml。结果 I组患者感觉阻滞持续时间和运动阻滞持续时间[腰丛（7.8±4.2, 5.7±3.1）h、坐骨神经（8.3±3.6, 6.5±3.8）h]明显短于II组[腰丛（16.3±6.5, 10.9±4.2）h、坐骨神经（17.3±5.2, 11.2±3.5）h]和III组[腰丛（24.2±5.8, 14.6±5.1）h、坐骨神经（24.7±4.4, 13.6±4.8）h]（P0.01），II组患者感觉阻滞持续时间和运动阻滞持续时间明显短于III组（P0.01）。I组患者48h舒芬太尼的消耗量、按压总次数和有效次数比II、III组高(P0.05）。结论 5mg和10mg地塞米松均能延长0.4%罗哌卡因腰丛-坐骨神经阻滞作用时间，10mg地塞米松较5mg地塞米松延长罗哌卡因作用时间长。 【关键词】 罗哌卡因，地塞米松，神经阻滞 Effect of different doses dexamethasone on action of ropivacaine Zhang Dazhi1，Wang Dongxin2 Wang Huaijiang1, 1 Department of anesthesiology, Beijing Ji Shuitan hospital, Beijing 100035, China 2 Department of anesthesiology, The first hospital of Peking University, Beijing 100034, China 【Abstract】　objective To compare effect of different doses dexamethasone on the action of ropivacaine. Methods　Sixty patients were randomly allocated into three groups with 20 cases each. Guided by a nerve stimulator, lumbar plexus combined sciatic nerve block was performed with 1%ropivacaine 20ml plus normal saline (NS) 30ml in group I, 1%ropivacaine 20ml plus dexamethasone 5mg and normal saline (NS) 29ml in group II, or 1%ropivacaine 20ml plus dexamethasone 10mg and normal saline (NS) 28ml in group III. Results The durations of sensory and motor blockade in group I were [lumbar plexus（7.8±4.2, 5.7±3.1）h and sciatic nerve（8.3±3.6, 6.5±3.8）h ] ,respectively ,which were significantly shorter than [（16.3±6.5, 10.9±4.2）h and（17.3±5.2, 11.2±3.5）h ] in group II and[（24.2±5.8, 14.6±5.1） h and （24.7±4.4, 13.6±4.8）h ] in group III(P0.01 ). The postoperative sufentanil consumption and PCA button press times in group I were more than that of group II and group III(P0.05）at 48h after operation. Conclusion 　Dexamethasone 5mg and 10mg significantly prolonged the action of ropivacaine in lumbar plexus com