CAJ | 학술논문

目的观察新型酰胺类纯S型左旋式长效局麻药盐酸罗哌卡因在中国人患者腋路臂丛神经阻滞的临床药效动力学特征.方法选择美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,年龄18～65岁,体重60～75 kg,上肢肘及肘关节部以下神经、肌腱粘连松解、移位及功能重建手术患者200例,均在腋路臂丛阻滞下手术.根据罗哌卡因的剂量不同随机分为4组(组Ⅰ 1.00 mg/kg、组Ⅱ1.25 mg/kg、组Ⅲ1.50 mg/kg、组Ⅳ2.00 mg/kg),每组50例,每组又依罗哌卡因的浓度不同分为5小组(0.15%、0.20%、0.25%、0.30%、0.35%),每小组10例.结果罗哌卡因对感觉、运动神经阻滞起效、完善和持续时间,组Ⅱ与组Ⅰ比较差异无统计学意义(P＞0.05),组Ⅲ、组Ⅳ与组Ⅰ比较差异有统计学意义(P＜0.05);运动神经阻滞程度,组Ⅰ和组Ⅱ在注药后90 min时肌力分别在M1和M2以下即感觉和运动神经阻滞呈分离现象,组Ⅲ和组Ⅳ在55 min和27 min达到M3和M4以上.结论罗哌卡因剂量在1.50～2.00 mg/kg、浓度在0.30%～0.35%范围内腋路臂丛神经阻滞,可达到较完善的感觉和运动神经阻滞;剂量在1.25 mg/kg,浓度在0.20%～0.25%范围内时感觉和运动神经阻滞起效、完善时间稍慢,持续时间稍短;剂量在1.00 mg/kg、浓度为0.15%～0.20%时,感觉和运动神经阻滞起效时间、完善时间较慢,且止血带痛较多,仅能满足无需止血带的清创缝合术.
목적 관찰신형선알류순S형좌선식장효국마약염산라고잡인재중국인환자액로비총신경조체적림상약효동역학특정.방법 선택미국마취의사협회(ASA)Ⅰ～Ⅱ급,년령18～65세,체중60～75 kg,상지주급주관절부이하신경、기건점련송해、이위급공능중건수술환자200례,균재액로비총조체하수술.근거라고잡인적제량불동수궤분위4조(조Ⅰ 1.00 mg/kg、조Ⅱ1.25 mg/kg、조Ⅲ1.50 mg/kg、조Ⅳ2.00 mg/kg),매조50례,매조우의라고잡인적농도불동분위5소조(0.15%、0.20%、0.25%、0.30%、0.35%),매소조10례.결과 라고잡인대감각、운동신경조체기효、완선화지속시간,조Ⅱ여조Ⅰ비교차이무통계학의의(P＞0.05),조Ⅲ、조Ⅳ여조Ⅰ비교차이유통계학의의(P＜0.05);운동신경조체정도,조Ⅰ화조Ⅱ재주약후90 min시기력분별재M1화M2이하즉감각화운동신경조체정분리현상,조Ⅲ화조Ⅳ재55 min화27 min체도M3화M4이상.결론 라고잡인제량재1.50～2.00 mg/kg、농도재0.30%～0.35%범위내액로비총신경조체,가체도교완선적감각화운동신경조체;제량재1.25 mg/kg,농도재0.20%～0.25%범위내시감각화운동신경조체기효、완선시간초만,지속시간초단;제량재1.00 mg/kg、농도위0.15%～0.20%시,감각화운동신경조체기효시간、완선시간교만,차지혈대통교다,부능만족무수지혈대적청창봉합술.
Objective To evaluate clinic pharmacodynamics of ropivacine hydrochloride,a new long-acting amide type local anaesthetic,in Chinese patients undergoing neurolysis and tendolysis of forearm through axillary brachial plexus block.Methods Two hundred ASAI-Ⅱ persons,aged 18-65,weighing 60～75 kg,undergoing neurolysis and tendolysis of forearm under axillary brachial plexus block were randomly assigned to 4 equal groups to received ropivacine of the doses of 1.00 mg/kg(Group Ⅰ),1.25 mg/kg(Group Ⅱ),1.50 mg/kg(Group Ⅲ),and 2.00 mg/kg(Group Ⅳ).Each group was subdivided into 5equal subgroups according to the concentrations(0.15%,0.20%,0.25%,0.30%,and 0.35%).The effects were analyzed.Resuits There was no significant diffefence in starting time,consummating time,and persisting time of sensory and motor nerve block between Group Ⅰ and Group Ⅱ(all P＞0.05).The starting time and consummating time of Group Ⅲ and Group Ⅳ were all significantly shorter than those of Group Ⅰ(all P＜0.05),and the persisting times of Groups Ⅲ and Ⅳ were all significantly longer than those of Group Ⅰ(P＜0.05).90 minutes after brachial plexus block the degrees of muscle strength Groups Ⅰ andⅡwere M1 and M2 respectively,hence,the sensory and motor nerves block was in dissociation.When motor never block was above M3 and M4 the interval of brachial plexus block was 55 min and 27 min in Group Ⅲ and Group Ⅳ respectively.Conclusion Sensory and motor never can be blocked perfectly when the dose of ropivacaine is between 1.5 mg/kg and 2.0 mg/kg and the concentration is between 0.30%-0.35%.When the doses of ropivacaine is 1.25 mg/kg and the concentration is 0.20%-0.25% the starting and consummating time are longer and persisting time is shorter.When the doses of ropivacaine is 1.00mg/kg and the concentration is 0.15%-0.20%the starting and consummating time are longer and only satisfies external debridement and suture without tourniquets.