中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
4期
412-414
,共3页
魏长娜%王琛%单海华%谢红
魏長娜%王琛%單海華%謝紅
위장나%왕침%단해화%사홍
酰胺类%筋膜%神经传导阻滞%关节成形术,置换,髋%镇痛
酰胺類%觔膜%神經傳導阻滯%關節成形術,置換,髖%鎮痛
선알류%근막%신경전도조체%관절성형술,치환,관%진통
Amides%Fascia%Nerve block%Arthroplasty,hip,replacement%Analgesia
目的 探讨不同浓度罗哌卡因连续髂筋膜腔隙阻滞用于全髋关节置换术病人术后镇痛的效果.方法 拟行单侧外侧入路全髋关节置换术病人160例,年龄52 ～ 84岁,体重指数18～26kg/m2,ASA分级Ⅰ-Ⅲ级,采用随机数字表法,将其分为4组(n=40):0.20％罗哌卡因组(A组)、0.25％罗哌卡因组(B组)、0.30％罗哌卡因组(C组)和0.35％罗哌卡因组(D组).手术结束后30 min内在超声引导下行患侧髂筋膜腔隙置管,各组注入相应浓度的罗哌卡因20 ml,随后接镇痛泵,无背景剂量,PCA量10 ml,锁定时间60 min,持续72 h.静息VAS评分≥4分时,静脉注射帕瑞昔布钠40 mg.于阻滞12、24、48和72 h时记录被动运动VAS评分和主动运动VAS评分,记录阻滞后72 h内罗哌卡因用量,记录阻滞期间帕瑞昔布钠使用情况和不良反应发生情况.结果 与A组比较,C组和D组被动运动VAS评分和主动运动VAS评分降低(P＜0.05),B组差异无统计学意义(P＞0.05),B组、C组、D组阻滞后72 h内罗哌卡因用量降低(P＜0.05);C组和D组被动运动VAS评分和主动运动VAS评分比较差异无统计学意义(P＞0.05),B组、C组和D组罗哌卡因用量比较差异无统计学意义(P＞0.05).4组帕瑞昔布钠使用率和呕吐发生率比较差异无统计学意义(P＞0.05).结论 罗哌卡因用于全髋关节置换术病人术后连续髂筋膜腔隙阻滞的适宜浓度为0.30％.
目的 探討不同濃度囉哌卡因連續髂觔膜腔隙阻滯用于全髖關節置換術病人術後鎮痛的效果.方法 擬行單側外側入路全髖關節置換術病人160例,年齡52 ～ 84歲,體重指數18～26kg/m2,ASA分級Ⅰ-Ⅲ級,採用隨機數字錶法,將其分為4組(n=40):0.20％囉哌卡因組(A組)、0.25％囉哌卡因組(B組)、0.30％囉哌卡因組(C組)和0.35％囉哌卡因組(D組).手術結束後30 min內在超聲引導下行患側髂觔膜腔隙置管,各組註入相應濃度的囉哌卡因20 ml,隨後接鎮痛泵,無揹景劑量,PCA量10 ml,鎖定時間60 min,持續72 h.靜息VAS評分≥4分時,靜脈註射帕瑞昔佈鈉40 mg.于阻滯12、24、48和72 h時記錄被動運動VAS評分和主動運動VAS評分,記錄阻滯後72 h內囉哌卡因用量,記錄阻滯期間帕瑞昔佈鈉使用情況和不良反應髮生情況.結果 與A組比較,C組和D組被動運動VAS評分和主動運動VAS評分降低(P＜0.05),B組差異無統計學意義(P＞0.05),B組、C組、D組阻滯後72 h內囉哌卡因用量降低(P＜0.05);C組和D組被動運動VAS評分和主動運動VAS評分比較差異無統計學意義(P＞0.05),B組、C組和D組囉哌卡因用量比較差異無統計學意義(P＞0.05).4組帕瑞昔佈鈉使用率和嘔吐髮生率比較差異無統計學意義(P＞0.05).結論 囉哌卡因用于全髖關節置換術病人術後連續髂觔膜腔隙阻滯的適宜濃度為0.30％.
목적 탐토불동농도라고잡인련속가근막강극조체용우전관관절치환술병인술후진통적효과.방법 의행단측외측입로전관관절치환술병인160례,년령52 ～ 84세,체중지수18～26kg/m2,ASA분급Ⅰ-Ⅲ급,채용수궤수자표법,장기분위4조(n=40):0.20％라고잡인조(A조)、0.25％라고잡인조(B조)、0.30％라고잡인조(C조)화0.35％라고잡인조(D조).수술결속후30 min내재초성인도하행환측가근막강극치관,각조주입상응농도적라고잡인20 ml,수후접진통빙,무배경제량,PCA량10 ml,쇄정시간60 min,지속72 h.정식VAS평분≥4분시,정맥주사파서석포납40 mg.우조체12、24、48화72 h시기록피동운동VAS평분화주동운동VAS평분,기록조체후72 h내라고잡인용량,기록조체기간파서석포납사용정황화불량반응발생정황.결과 여A조비교,C조화D조피동운동VAS평분화주동운동VAS평분강저(P＜0.05),B조차이무통계학의의(P＞0.05),B조、C조、D조조체후72 h내라고잡인용량강저(P＜0.05);C조화D조피동운동VAS평분화주동운동VAS평분비교차이무통계학의의(P＞0.05),B조、C조화D조라고잡인용량비교차이무통계학의의(P＞0.05).4조파서석포납사용솔화구토발생솔비교차이무통계학의의(P＞0.05).결론 라고잡인용우전관관절치환술병인술후련속가근막강극조체적괄의농도위0.30％.
Objective To investigate the efficacy of continuous fascia iliaca compartment block withdifferent concentrations of ropivacaine for postoperative analgesia in patients undergoing total hip arthroplasty.Methods One hundred and sixty ASA physical status Ⅰ or Ⅲ patients,aged 52-84 yr,body mass index 18-26 kg/m2,scheduled for total hip arthroplasty,were randomly divided into 4 groups (n =40 each) using a random number table:0.20％ ropivacaine group (group A),0.25％ ropivacaine group (group B),0.30％ ropivacaine group (group C) and 0.35％ ropivacaine group (group D).A catheter was inserted into the fascia iliaca compartment on the affected side within 30 min after operation.The corresponding concentrations of ropivacaine 20 ml were given in each group.The catheter was then connected to a patient-controlled analgesia pump programmed to deliver 10 ml with a lockout interval of 60 rin for postoperative analgesia (72 h).When VAS score at rest≥4,parecoxib sodium 40 mg was injected intravenously.At 12,24,48 and 72 h of blockade,the passive and active exercise VAS scores were recorded.The consumption of ropivacaine within 72 h after the end of blockade,and requirement for parecoxib sodium and development of adverse reactions during blockade were recorded.Results Compared with group A,the passive and active exercise VAS scores were significantly decreased in C and D groups (P ＜ 0.05),and no significant change was found in group B (P ＞ 0.05),and the consumption of ropivacaine within 72 h after the end of blockade was significantly decreased in B,C and D groups (P ＜ 0.05).There was no significant difference in the passive and active exercise VAS scores between group C and group D (P ＞ 0.05).There was no significant difference in consumption of ropivacaine within 72 h after the end of blockade between B,C and D groups (P ＞ 0.05).There were no significant differences in the requirement for parecoxib sodium and incidence of vomiting among the four groups (P ＞ 0.05).Conclusion The optimum concentration of ropivacaine is 0.30％ when used for continuous fascia iliaca compartment block in patients undergoing total hip arthroplasty.
