红细胞包蔽舒芬太尼对臂丛神经阻滞的影响
Effect of erythrocyte encapsulation of sufentanil on brachial plexus block
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摘要:目的 观察罗哌卡因复合红细胞包蔽舒芬太尼在臂丛神经阻滞术后的镇痛效果。方法 选取90例择期行肱骨或锁骨切开复位内固定术患者为研究对象, 将其随机分为对照组(C组)、罗哌卡因复合舒芬太尼组(S组)和罗哌卡因复合红细胞包蔽舒芬太尼组(R组), 每组30例。每组超声下行臂丛神经阻滞。C组使用0.375%罗哌卡因20 mL, S组使用0.375%罗哌卡因复合舒芬太尼0.5μg/mL的混合液20 mL, R组使用0.375%罗哌卡因复合红细胞包蔽同等剂量舒芬太尼的混合液20 mL。3组术后均连接静脉自控镇痛泵。观察术后镇痛效果, 并记录感觉、运动阻滞的起效时间和镇痛泵的使用情况及不良反应。结果 3组患者感觉和运动阻滞起效时间比较, 差异无统计学意义(P>0.05)。与C组比较, S组和R组术后12 h的静态及动态视觉模拟评分法(VAS)评分降低, 差异有统计学意义(P < 0.05); 与S组比较, R组术后24 h的静态VAS评分降低, 差异有统计学意义(P < 0.05); 与S组比较, R组术后12 h和24 h的动态VAS评分均降低, 差异有统计学意义(P < 0.05)。与C组比较, S组和R组镇痛泵首次按压时间较晚, 按压次数较少, 差异有统计学意义(P < 0.05)。与S组比较, R组镇痛泵首次按压时间较晚, 按压次数较少, 差异有统计学意义(P < 0.05)。3组均未出现恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应。结论 罗哌卡因复合红细胞包蔽舒芬太尼可明显延长臂丛神经阻滞的镇痛时间, 并无明显并发症。Abstract:Objective To observe the analgesic effect of ropivacaine combined with erythrocyte encapsulated sufentanil after brachial plexus block.Methods Ninety patients undergoing elective humeral or clavicular osteotomy and repositioning internal fixation were randomly divided into control group (group C), ropivacaine combined with sufentanil group (group S) and ropivacaine combined with erythrocyte encapsulated sufentanil group (group R), with 30 cases in each group. Brachial plexus block was performed on ultrasound in all groups. Group C was treated with 0.375% ropivacaine 20 mL, group S was treated with 0.375% ropivacaine combined with 0.5μg/mL sufentanil, group R was treated with 20 mL of a mixture of 0.375% ropivacaine complex red blood cells encapsulated with the same dose of sufentanil. All groups were connected to an intravenous self-administered analgesia pump postoperatively. The effect of postoperative analgesia was observed. The time of onset of sensory and motor blockade and the use of analgesic pump and adverse effects were recorded.Results There was no statistically significant difference in the onset time of sensory and motor block in the three groups(P>0.05). Compared with group C, static and dynamic visual analogue scale(VAS) scores at 12h postoperatively were lower in groups S and R(P < 0.05). Compared with group S, the static VAS score of group R at 24h after operation was decreased (P < 0.05). Compared with group S, the dynamic VAS scores in group R at 12h and 24h after surgery were decreased, and the difference was statistically significant (P < 0.05). Compared with group C, groups S and R had later first press time of the analgesic pump and fewer pressing times (P < 0.05). Compared with group S, the group R had first press time of the analgesic pump and fewer pressing times, the differences were statistically significant (P < 0.05).Conclusion Ropivacaine combined with erythrocyte encapsulated sufentanil could significantly prolong the analgesic time of brachial plexus block without obvious complications.
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