摘要目的 研究对行臂神经丛阻滞的患者丁丙诺啡加入局麻药中与肌肉注射两种镇痛方式对麻醉效果、麻醉维持时间、术后镇痛等方面的作用.方法 选择2009年9月至2009年12月天津市天津医院60例拟行上肢、手部手术的患者,数字随机法分为3组.A组(局麻药中无丁丙诺啡组,n=20);B组(局麻药中加丁丙诺啡2μg/kg组,n=20);C组(麻醉前肌肉注射丁丙诺啡2 μg/kg组,n=20).用B/BRAMN-STIMMPLEX-DIG神经刺激仪引导定位行腋路臂神经丛阻滞.3组患者记录(1)麻醉起效时间;(2)麻醉维持时间;(3)手术时间;(4)术后4、8、12、24、36、48、72 h各时间点的疼痛评分;(5)恶心、呕吐的发生率;(6)观察其他副作用.结果 3组患者年龄、体重、性别、手术时间之间比较,差异无统计学意义(P＞0.05);麻醉起效时间3组之间比较差异无统计学意义(P＞0.05).麻醉维持时间:A、C组明显短于B组(P＜0.01);疼痛评分4 h时A与B、C组之间差异无统计学意义(P＞0.05);8、12、24 h时A组极显著高于B、C组(P＜0.01),36、48、72 h时A组与B、C组之间差异无统计学意义(P＞0.05);恶心发生率A组为10%,B组20%,C组20%.呕吐发生率A、B组为0,C组30%.结论 丁丙诺啡加入局麻药中进行臂神经丛阻滞或阻滞前肌肉注射丁丙诺啡都可以取得满意的术后镇痛效果,丁丙诺啡加入局麻药中进行臂神经丛阻滞麻醉可延长麻醉维持时间、对术后镇痛有明显疗效,且不良反应较少.

abstractsObjective To study the anesthetic effect of brachial plexus block by adding buprenorphine in local anesthetics and patients with intramuscular injection , and observe the anesthesia effects, the anesthesia maintenance time, postoperative analgesia effects. Methods 60 cases of upper limb to line, hand surgery patients from Sep. 2009 to Dec. 2009 in Tianjin Hospital were randomly divided into 3groups. A (local anesthetics without buprenorphine, n = 20); B group (plus 2 μg/kg buprenorphine in local anesthetics, n = 20); C group ( intramuscular injection 2 μg/kg buprenorphine before anesthesia ,n =20). With B/ BRAMN-STIMMPLEX-DIG nerve stimulator guided positioning of brachial plexus block of axillary line. 3 groups of patients recorded ( 1 )the onset time of narcotic; (2) the duration of anesthesia;(3)the surgery time; (4)the pain score of postoperative 4, 8, 12, 24, 36, 48, 72 h; (5)the incidence of nausea and vomiting; (6)observed other side effects. Results the patients' age, weight, sex, operation time of the 3 groups had no significant difference between the comparison ( P ＞ 0. 05 ); anesthesia onset time between the 3 groups showed no significant difference ( P ＞ 0. 05). Duration of anesthesia: A, C group was significantly shorter than the B group (P ＜0. 01 ); pain score at 4 h, A and B, C no significant difference between groups ( P ＞0.05 ); 8、12、24 h, when group A was significantly higher than the B, C group ( P ＜0. 01 ), 36、48、72 h when the A group and B, C no significant difference between groups ( P ＞ 0. 05 ); the incidence of nausea A group 10%, B group 20% , C group 20%. Vomiting, the incidence of A, B group was 0, C group 30%. Conclusion Buprenorphine adding local anesthetics in brachial plexus block or intramuscular injection buprenorphine before a block can be to achieve a satisfactory effect of postoperative analgesia, buprenorphine adding local anesthetics in brachial plexus block Narcotic maintenance of anesthesia time can be extended and have a significant effect and fewer adverse reactions.