丙帕他莫与布托啡诺超前镇痛辅助臂丛麻醉效果比较.docVIP

丙帕他莫与布托啡诺超前镇痛辅助臂丛麻醉效果比较 　　[摘要] 目的 观察盐酸丙帕他莫、酒石酸布托啡诺、盐酸哌替啶术前超前镇痛辅助手部显微外科手术臂丛麻醉的效果。 方法 选择ASA Ⅰ～Ⅱ级手外科手术患者120例，将其随机分为三组，每组各40例。所有患者都采用神经刺激器辅助定位下行臂丛神经阻滞，使用药物0.5%罗哌卡因30 mL。麻醉前15 min Ⅰ组静脉注射酒石酸布托啡诺1 mg，Ⅱ组注射盐酸丙帕他莫2 mg，Ⅲ组静脉注射盐酸哌替啶50 mg，手术开始前再次重复上述操作。观察记录患者麻醉起效时间、麻醉维持时间、麻醉效果和术中、术毕、术后4 h的VAS评分和镇静评分及不良反应的发生情况。 结果 Ⅰ、Ⅱ组麻醉维持时间显著长于Ⅲ组（P 　　[关键词] 显微外科；超前镇痛；盐酸丙帕他莫；酒石酸布托啡诺 　　[中图分类号] R641 [文献标识码] A [文章编号] 1673-7210（2012）01（b）-096-03 　　 　　Comparison of Propacetamol and Butorphanol′s effects in preemptive analgesia for brachial plexus 　　CHEN Xiaodong SUN Xiaochong HUA Hao DING Haozhong 　　Department of Anesthesiology, the Ninth People′s Hospital of Wuxi City Hand Surgery Hospital of Wuxi City, Jiangsu Province, Wuxi 214062, China 　　[Abstract] Objective To observe the effects of Propacetamol, Butorphanol and Pethidine Hydrochloride in preemptive analgesia for hand microsurgeries to brachial plexus. Methods 120 patients (ASA Ⅰ-Ⅱ) were randomly divided into 3 groups, with 40 cases in each group. Neuro-Stimulator was used to help position the lower brachial plexus′s nerve blocking with the use of 30 mL 0.5% Ropivacaine. 1 mg Butorphanol were injected to group Ⅰ, 2 mg Propacetamol to group Ⅱ, and 50 mg Pethidine Hydrochloride to group Ⅲ 15 minutes before anesthesia, then the above procedure were repeated before the surgery. The duration as well as the effects of the anesthesia, the VAS scores during the surgery, right after the surgery and 4 hours after the surgery, the calmness score and any adverse reaction were recorded. Results The duration of anesthesia of group Ⅰ and Ⅱ was longer than that of group Ⅲ (P 　　1.3 观察项目 　　术中常规观察记录HR、BP、平均动脉压（MAP）、SpO2、ECG的变化。记录，①起效时间：观察阻滞完成至镇痛完善，可以开始手术的时间。②麻醉维持时间：观察麻醉起效后至麻醉消失的时间。③麻醉效果：以针刺法测定手术部位疼痛、感觉消失的程度，注药后15～30 min内每5分钟测定1次，根据患者对手术刺激的反应，将麻醉效果分为优、良、差。优：手术时完全无痛；良：手术时轻微疼痛，需辅以镇静药；差：手术时剧烈疼痛，需追加臂丛神经阻滞、局部麻醉或辅助大量镇痛药方能完成手术。其中麻醉效果优良者即为阻滞成功[2]。④三组患者术中、术毕、术后4 h双盲镇痛VAS评分、镇静评分。VAS评分采用视觉模拟评分法：0分为无痛，10分为最痛，＜3分为优良，3～5分为满意，＞5分为不满意。镇静评分采用Ramesay评分法：1分为不安静