林雷++++++陈春++++++侯俊++++++杨萍

[摘要] 目的 探讨静脉注射不同剂量地塞米松联合超声引导肌间沟臂丛神经阻滞对行肩部手术患者术后镇痛效果的影响。 方法 选择宜昌市中心人民医院2014年6月～2015年10月80例于肌间沟臂丛神经阻滞下行肩关节镜手术患者，采用电脑生成的随机数字分为四组：阻滞前分别静注生理盐水（A组，n = 20）、0.025 mg/kg地塞米松（B组，n = 20）、0.05 mg/kg地塞米松（C组，n = 20）、0.1 mg/kg地塞米松（D 组，n = 20）。主要指标：术后48 h首次需求镇痛时间；次要指标：术后24、48 h无痛或轻度疼痛及术后24 h阻滞侧上肢肌力未完全恢复患者例数，术后48 h累积镇痛药物消耗，睡眠干扰、恶心呕吐等不良事件，及患者对麻醉的满意率等。 结果 C组和D组患者术后48 h首次需求镇痛中位时间明显长于A组（P < 0.01），但C、D组间比较差异无统计学意义（P > 0.05）；四组间术后24、48 h无痛或轻度疼痛，术后24 h阻滞侧上肢肌力未完全恢复，48 h内不需镇痛剂，曲马多的用量及使用哌替定患者例数等指标比较，差异均无统计学意义（P > 0.05），但D组术后48 h双氯芬酸钠栓的使用量明显低于A组（P < 0.05）；C组和D组睡眠干扰患者明显少于A组（P < 0.05），且D组患者麻醉满意率高于A组（P < 0.05）。 结論 静注0.05 mg/kg或0.1 mg/kg地塞米松可延长肌间沟臂丛神经阻滞肩部手术术后镇痛时间，静注0.1 mg/kg地塞米松患者麻醉满意率更高。

[关键词] 肌间沟；臂丛神经阻滞；地塞米松

[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0067-04

A randomised controlled trial of intravenous Dexamethasone combined with interscalene brachial plexus blockade guided by ultrasound in shoulder surgery

LIN Lei1 CHEN Chun1 HOU Jun2 YANG Ping2

1.Department of Anesthesia， the First College of Clinical Medical Science， Three Gorges University， Hubei Province， Yichang 443003， China； 2.Department of Anesthesia， Yichang Central People's Hospital， Hubei Province， Yichang 443003， China

[Abstract] Objective To investigate the effects of intravenous injection of different doses of Dexamethasone combined with ultrasound-guided interscalene bronchial plexus block on postoperative analgesia in patients underwent shoulder surgery. Methods 80 cases of patients underwent shoulder arthroscopy under interscalene brachial plexus blockade in Yichang Central People's Hospital from June 2014 to October 2015 were chosen and randomly divided into four groups： intravenous injection of saline （group A， n=20）， 0.025 mg/kg Dexamethasone （group B， n=20）， 0.05 mg/kg Dexamethasone （group C， n=20）， 0.1 mg/kg Dexamethasone （group D， n=20） before blockade， respectively. Outcomes for 48 h were recorded. Primary endpoint was the time to first postoperative analgesic required. No or mild pain at 24 h and 48 h， weakness at 24 h， cumulative analgesic consumption， sleep disturbance， nausea and vomiting， and satisfaction were considered as secondary outcomes. Results The median time to first postoperative analgesic required was significantly longer in group C and group D than that in group A （P < 0.01）， but there was no significant difference between group C and group D （P > 0.05）. Among the four groups， no or mild pain at 24 h and 48 h， weakness at 24 h， no analgesia required， the amount of Tramadol and Dolantin required were compared， there were no significant differences （P > 0.05）， but the amount of Diclofenac Sodium Suppository was lower in group D than that in group A （P < 0.05）. The incidence of sleep disturbance in group C and group D was less than that in group A （P < 0.05）， and patients' anesthesia satisfaction rate in group D was higher than that in group A （P < 0.05）. Conclusion Intravenous injection of 0.05 mg/kg or 0.1 mg/kg Dexamethasone can extend the duration of postoperative analgesia provided by interscalene brachial plexus block， patients' satisfaction with anesthesia by using 0.1 mg/kg Dexamethasone is higher.

[Key words] Interscalene； Plexus blockade； Dexamethasone

地塞米松作為长效糖皮质激素在急慢性疼痛及区域麻醉中应用广泛。研究表明，神经周围使用地塞米松可延长多数神经阻滞时间[1-7]，但可能是其经全身吸收后产生的效应，而不是本身的局部作用[8]，且目前使用仍有顾虑，主要是担心地塞米松可能具有神经毒性[9-11]。近年发现，静脉注射地塞米松可延长不同人群不同手术后的镇痛时间[12-13]，且静注与神经周围注射10 mg地塞米松在延长罗哌卡因肌间沟镇痛时间上无显著差异[14]，在锁骨上阻滞时也有类似报道[15]。但……