张伟　张勇　张中军　华海峰

[摘要] 目的 探讨硫酸镁在罗哌卡因臂丛神经阻滞中的应用效果。 方法 选择本院2014年1月～2015年10月择期在腋路臂丛神经阻滞下行上肢手术的患者50例，随机均分为两组，试验组给予罗哌卡因和硫酸镁混合液阻滞，对照组给予罗哌卡因和生理盐水。观察两组患者阻滞前，阻滞后30、60、120 min的HR、MAP变化以及阻滞持续时间；采用视觉模拟评分法（VAS）观察并记录术后8、12、16、24 h的疼痛程度；记录术后首次给镇痛药曲马多的时间和24 h内总药量；观察两组患者的神经阻滞后不良并发症发生情况。 结果 两组患者神经阻滞前后各时间点的HR、MAP比较，差异无统计学意义（P>0.05）。与对照组比较，试验组的神经阻滞时间延长，术后各时间点的VAS评分降低，首次给曲马多的时间较晚，24 h内总药量较少（P<0.05）。两组均无并发症出现。 结论 硫酸镁能够显著延长罗哌卡因臂丛神经阻滞的时间，减少术后镇痛药的使用量，为术后提供良好的镇痛效果而无并发症出现。

[关键词] 硫酸镁；罗哌卡因；臂丛神经阻滞

[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721（2016）02（c）-0046-04

[Abstract] Objective To explore the application effect of magnesium sulfate in brachial plexus block with ropivacaine. Methods 50 patients scheduled for upper extremity surgery under axillary brachial plexus block received by our hospital from January 2014 to October 2015 were selected，and they were evenly and randomly divided into two groups.Experimental group was mixed liquid of ropivacaine and magnesium sulfate block，while control group was given ropivacaine and saline.The change of HR and MAP before block，after 30， 60 and 120 min block，and block sustained time in two groups was observed respectively.The pain degree after 8，12，16 and 24 h operation was observed and recorded by using VAS.The time of analgesic remedy-tramadol given for the first time after operation and total dosage within 24 h was recorded respectively.The incidence of adverse complication after nerve block in two groups was observed. Results There was no statistical difference of HR and MAP at different time before and after nerve block in patients of two groups （P>0.05）.Compared with control group，the time of nerve block in experimental group prolonged，VAS score decreased at different time after operation，the time of tramadol given for the first time was later，and total dosage within 24 h was fewer （P<0.05）.There was no complication appeared in two groups. Conclusion Magnesium sulfate can obvious prolong the time of ropivacaine used for brachial plexus block，reduce the dosage of postoperative analgesic drug and provide good analgesic effect for postoperation but has no complication appearing.

[Key words] Magnesium sulfate；Ropivacaine；Brachial plexus block

臂丛神经阻滞是上肢手术常用的麻醉方法，术后患者仍会感到中到重度疼痛，有效的术后镇痛能够加快患者术后恢复，缩短住院时间。硫酸镁在临床中具有广泛作用，肌内注射或静脉滴注可用于缓解妊娠高血压子痫、破伤风惊厥，救治高血压危象，也常用于纠正室性心动过速；口服可用于治疗便秘；局部外用热敷可抗炎消肿。最近的研究表明[1-2]，硫酸镁可以延长布比卡因和利多卡因神经阻滞的作用时间。罗哌卡因具有心脏毒性小，作用时间长，安全范围广等优点，已被广泛应用于神经阻滞麻醉中，而硫酸镁在罗哌卡因神经阻滞中的研究仍然较少。本研……