【摘要】 目的探讨注射不同剂量地塞米松应用于超声引导下罗哌卡因臂丛神经阻滞中的效果差异,为临床麻醉提供参考。方法选取右江民族医学院附属医院2019年3月-2020年1月行臂丛神经阻滞的上肢手术患者120例,按照随机数字表法将其分成A、B、C、D四组,每组30例。A组静注生理盐水5 ml,B组静注地塞米松0.10 mg/kg+生理盐水混合液5 ml,C组静注地塞米松0.15 mg/kg+生理盐水混合液5 ml,D组静注地塞米松0.20 mg/kg+生理盐水混合液5 ml。比较各组行神经阻滞后感觉、运动阻滞达到完全的时间及持续时间,术后首次需要使用曲马多镇痛的时间,术后12、24和48 h曲马多的累积使用量,术后6、12、24、48 h视觉模拟疼痛评分(VAS)及不良反应。结果四组感觉、运动阻滞达到完全的时间比较,差异无统计学意义(P>0.05);C组、D组感觉、运动阻滞持续时间长于A组、B组(P<0.05),C组与D组感觉、运动阻滞持续时间比较,差异无统计学意义(P>0.05);A组、B组术后首次使用曲马多镇痛的时间早于C组、D组(P<0.05);C组、D组术后各时间段曲马多累积使用量均少于A组、B组(P<0.05);C组、D组患者术后各时间段VAS评分均低于A组、B组(P<0.05);C组术后首次使用曲马多镇痛的时间、术后各时间段曲马多累积使用量及VAS评分与D组比较,差异无统计学意义(P>0.05);A组不良反应的发生情况明显多于其他三组(P<0.05)。结论静脉注射0.15 mg/kg地塞米松可明显延长罗哌卡因臂丛神经阻滞的镇痛时效,达到满意阻滞效果,不良反应少,值得临床应用。更多还原

【Abstract】 Objective To explore the effect of different doses of de xamethasone in ultrasound-guided brachial plexus block with ropivacaine, and to provide references for clinical anesthesia.Methods A total of 120 patients with upper limb surgery undergoing brachial plexus block in the Affiliated Hospital of Youjiang Medical College for Nationalities from March 2019 to January 2020 were selected and divided into four groups according to the random number table method, with 30 cases in each group. Group A was given normal saline 5 ml, group B was given dexamethasone 0.10 mg/kg and normal saline 5 ml, group C was given dexamethasone 0.15 mg/kg and normal saline 5 ml, group D was given dexamethasone 0.20 mg/kg and normal saline 5 ml. The time and duration of complete sensory and motor block after nerve block in each group were compared. Tramadol was used for the first time after operation. The cumulative use of tramadol at 12, 24 and 48 h after operation, visual analogue pain score(VAS) at 6, 12, 24 and 48 h after operation and adverse reactions were compared.Results There was no significant difference in the complete time of sensory and motor block among the four groups(P>0.05). The durations of sensory and motor block in group C and group D were longer than those in group A and group B( P<0.05);while there was no significant difference in the duration of sensory and motor block between group C and group D( P >0.05). The first postoperative analgesia with tramadol in group A and group B was earlier than that in group C and group D( P <0.05); and the cumulative use of tramadol in group C and group D at each postoperative period was less than that in group A and group B(P<0.05). The VAS scores of group C and group D at each postoperative period were lower than those of group A and group B(P<0.05). There was no statistically significant difference in the time for the first use of tramadol for analgesia, the cumulative use of tramadol in each postoperative period and VAS score between group C and group D(P>0.05). The incidence of adverse reactions in group A was higher than that in the other three groups( P<0.05).Conclusion Intravenous injection of 0.15 mg/kg dexamethasone can significantly prolong the analgesic time of ropivacaine brachial plexus block, and achieve satisfactory block effect with less adverse reactions, which is worthy of further clinical promotion.更多还原