超低浓度臂丛神经阻滞麻醉在上肢急诊创伤手术中的应用
Application of ultra-low concentration brachial plexus block anesthesia in emergency upper limb trauma sur-gery
徐春红 1季尚燕 2杜敬贤 1陈纪1
作者信息
- 1. 310022 浙江杭州,浙江省医疗健康集团杭州医院(杭州杭钢医院)麻醉科
- 2. 310022 浙江杭州,浙江省医疗健康集团杭州医院(杭州杭钢医院)手术室
- 折叠
摘要
目的 探讨0.20％罗哌卡因复合0.50％利多卡因臂丛神经阻滞麻醉在上肢急诊创伤手术应用中的安全性和有效性.方法 选择上肢急诊创伤手术患者202 例进行回顾性研究,按照随机数字表法分为超低浓度组和常规浓度组,各101 例.常规浓度组采用0.25％罗哌卡因复合0.66％利多卡因混合液进行臂丛神经阻滞;超低浓度组采用0.20％罗哌卡因复合0.50％利多卡因混合液进行臂丛神经阻滞.比较两组患者的麻醉效果,术中的活动医嘱配合率、肌力状态、麻醉并发症,以及止血带不适感.结果 超低浓度组患者的麻木感出现时间、疼痛消失时间均长于常规浓度组,差异均有统计学意义(t分别=-4.83、-2.15,P 均＜0.05);而肌力完全恢复时间、疼痛恢复时间、出现止血带不适感时间、麻醉作用时间均短于常规浓度组,差异均有统计学意义(t分别=26.90、10.08、9.33、18.69,P均＜0.05),超低浓度组术中活动医嘱配合率高于常规浓度组,差异有统计学意义(χ2=72.31,P＜0.05),超低浓度组手术结束、送返病房时间点的疼痛评分以及术中肌力等级均高于常规浓度组,差异均有统计学意义(t分别=-22.47、-33.16、-27.71,P 均＜0.05).超低浓度组麻醉总并发症发生率低于常规浓度组,差异有统计学意义(χ2=8.14,P＜0.05).结论 超低浓度0.20％罗哌卡因复合0.50％利多卡因可用于上肢急诊创伤手术臂丛神经阻滞麻醉,足以满意临床操作需求,术中活动医嘱配合度高,且安全有效,麻醉并发症更少.
Abstract
Objective To explore the safety and effectiveness of brachial plexus block anesthesia using 0.20%ropiva-caine combined with 0.50%lidocaine in upper limb emergency trauma surgery.Methods A total of 202 patients with emergency upper extremity trauma surgery were selected for retrospective study.The patients were divided into low con-centration group and conventional concentration group according to random number table method,101 cases in each group.The conventional concentration group was treated with 0.25%ropivacaine combined with 0.66%lidocaine for bra-chial plexus block,the low concentration group was treated with 0.20%ropivacaine combined with 0.50%lidocaine for brachial plexus block.The results of anesthesia,the proportion of doctor's order coordination,muscle strength status,anes-thesia complications,and tourniquet discomfort were compared between the two groups.Results The time of numbness occur and pain disappearance in low concentration group were longer than those in conventional concentration group,and the differences were statistically significant(t=-4.83,-2.15,P＜0.05).The time of complete muscle strength recovery,pain recovery,tourniquet discomfort and anesthetic action were all shorter than those in the conventional concentration group,and the differences were statistically significant(t=26.90,10.08,9.33,18.69,P＜0.05).The proportion of doctor's order coordination in the low concentration group was higher than that in the conventional concentration group.The differ-ence was statistically significant(χ2=72.31,P＜0.05).The pain score at the end of the operation and the time of return to the ward,and intraoperative muscle strength lev-els in the low concentration group were higher than those in the conventional concentration group,and the differences were statistically significant(t=-22.47,-33.16,-27.71,P＜0.05).The incidence of anesthesia complications in the low concentration group was lower than that in the conventional concentration group(χ2=8.14,P＜0.05).Conclusion Low concentration 0.20%ropivacaine combined with 0.50%lidocaine can be used for bra-chial plexus block anesthesia in upper limb emergency trauma surgery,which is sufficient for operational requirements with better safety,better patient cooperation,and less anesthesia complications.
关键词
罗哌卡因/利多卡因/臂丛神经阻滞麻醉/急诊创伤手术Key words
ropivacaine/lidocaine/brachial plexus block anesthesia/emergency trauma surgery引用本文复制引用
出版年
2024
NETL
NSTL
万方数据