本文關(guān)鍵詞： 羅哌卡因 羥考酮 臂叢神經(jīng)阻滯 臨床觀察　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:0.5%鹽酸羅哌卡因注射液復合少量鹽酸羥考酮注射液應用于臂叢神經(jīng)阻滯的臨床效果觀察。方法:選用我院2016.06-2016.12期間于手足外科需行上肢手術(shù),并需要進行麻醉的擇期手術(shù)患者160人,該160人選擇年齡介于18-50歲之間,性別無特殊選擇,麻醉ASA I-II級,簽署知情同意書后,將所選患者隨機分為兩組,分別記為A組、B組�；颊呷胧以u估無明顯異常,行必須的監(jiān)測后,超聲引導下于患側(cè)鎖骨上窩處行神經(jīng)阻滯,其中入選A組患者使用含有0.5mg鹽酸羥考酮注射液的0.5%鹽酸羅哌卡因注射液20ml,B組使用單純0.5%羅哌卡因注射液20ml,穿刺過程未損傷患者神經(jīng)、血管,注射完成后可見局麻藥物完全包繞臂叢神經(jīng)束。如發(fā)生以下情況時將患者踢出統(tǒng)計范圍:1、藥物注射過程中出現(xiàn)明顯神經(jīng)刺激癥狀的患者;2、藥物注射過程中出現(xiàn)局麻中毒癥狀或有局麻藥物中毒傾向的患者;3、神經(jīng)穿刺過程中藥物回抽有血,無論調(diào)整后是否阻滯成功,考慮排除蛋白、血液等相關(guān)干擾因素,此類患者排除統(tǒng)計范圍之列;4、由于過度肥胖,或過度消瘦不能安全、明確的將局麻藥物注射至神經(jīng)周圍的患者;5、過度緊張,不能完全配合的患者。將以上患者排除后,對余下患者進行統(tǒng)計。分別記錄穿刺結(jié)束后5min、15min、30min時阻滯區(qū)域橈骨莖突處對100Pa的壓強(即1牛的壓力作用于2ml針頭)下的痛覺NRS評分、10℃下手背處溫覺感受、肘部肌力評分、不適反應(如頭暈、皮膚瘙癢等)以及患者生命體征。統(tǒng)計學方法:應用SPSS 19.0統(tǒng)計軟件進行分析,計量資料時采用均數(shù)±標準差(`x±s)來表示,多組間均數(shù)的比較采用單因素方差進行分析,組間多重數(shù)值比較采用Tukey檢驗。計數(shù)資料比較采用χ2檢驗。P0.05為差異有統(tǒng)計學意義。結(jié)果:A組在神經(jīng)阻滯完成后5min時疼痛NRS評分較B組明顯下降(P0.05),15min時NRS評分較B組明顯下降(P0.05),30min時疼痛NRS評分無明顯差異;5min時受神經(jīng)阻滯測皮膚溫覺感受A組較B組明顯遲鈍,15min溫覺感受較B組明顯遲鈍,30min時A組與B組溫覺感受無明顯差異;5min時A組肌力較B組下降明顯,15min時A組肌力較B組下降明顯,30min時A組與B組肌力均為0級,無統(tǒng)計學差異;圍術(shù)期兩組患者均未出現(xiàn)明顯不適及副作用,無統(tǒng)計學差異;A組患者生命體征較術(shù)前波動范圍小于20%較B組有明顯下降(P0.05)。結(jié)論:目前采用超聲引導下神經(jīng)阻滯,將以前的完全盲探性操作進展為可視化操作,使得臂叢神經(jīng)阻滯成功率更高,0.5%鹽酸羥考酮注射液復合0.5mg鹽酸羥考酮注射液用于臂叢神經(jīng)阻滯于單獨使用0.5%鹽酸羥考酮注射液阻滯效果最終兩組患者無明顯差異,但復合0.5mg鹽酸羥考酮注射液應用于臂叢神經(jīng)阻滯時起效更快,患者圍術(shù)期情緒更穩(wěn)定,患者舒適度更高,圍術(shù)期并發(fā)癥無明顯增多,仍不失為臨床應用的好方法。
[Abstract]:Objective: to observe the clinical effect of 0.5% ropivacaine hydrochloride injection combined with a small amount of hydroxycodone hydrochloride injection in brachial plexus block. There were 160 patients who needed anaesthesia for elective operation. The patients were divided into two groups randomly after signing the informed consent form, who had chosen between 18 and 50 years old, had no special choice of sex, had no special choice of sex, and had signed the informed consent form. The patients were recorded as group A and B respectively. There was no obvious abnormality in the assessment of the patients' room. After the necessary monitoring, the supersonic nerve block was performed at the supraclavicular fossa on the affected side. Group A received 0.5% ropivacaine hydrochloride injection 20ml containing 0.5 mg hydroxycodone hydrochloride injection. Group B received only 0.5% ropivacaine injection 20ml. The nerve and blood vessels of the patients were not damaged during puncture. Local anesthetic can be seen completely wrapped around the brachial plexus nerve bundle after injection. If the following conditions will be kicked out of the statistical range of 1, the drug injection of patients with obvious symptoms of nerve stimulation, drug injection process appear. Patients with symptoms of anaesthesia or with a tendency to be poisoned by local anesthetic drugs have their blood drawn back in the course of nerve puncture. Whether the adjustment is successful or not, taking into account the exclusion of protein, blood and other related interference factors, such patients exclude the statistical scope of 4, because of excessive obesity, or excessive weight loss is not safe, The patients who were injected with local anesthetic drugs into the peripheral nerves were overstressed and could not cooperate completely. After the above patients were excluded, The pain NRS scores at 100Pa in the styloid process of the radius at the end of 5 min and 15 min and 30 min after the puncture were recorded, respectively. The pain NRS scores at 10 鈩，

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