中国临床药学杂志

目的 探讨罗哌卡因与左布比卡因角袋注射对锁骨上臂丛神经阻滞（SCBPB）患者膈肌功能及术后疼痛介质表达的影响。方法 选取2020年1月至2021年6月医院80例SCBPB患者作为研究对象，依据随机数字表法分为2组，各40例。对照组予以左布比卡因角袋注射，观察组予以罗哌卡因角袋注射。观察并比较2组神经阻滞情况、术后镇痛泵及舒芬太尼使用情况、膈肌麻痹情况、不良反应发生情况及心肌指标[血清肌钙蛋白（CTn I）和肌酸激酶同工酶（CK-MB）]水平。结果 观察组感觉阻滞及运动阻滞起效时间均较对照组长，感觉阻滞及运动阻滞持续时间均较对照组短（P <0.05）;2组首次臂丛神经阻滞成功率相比，差异无统计学意义（P> 0.05）。观察组术后首次按压镇痛泵时间短于对照组（P <0.05），阻滞30 min平静及用力呼吸时膈肌总麻痹率低于对照组（P <0.05），给药后24 h血清CTn I、CK-MB水平均低于对照组（P <0.05）。2组不良反应发生率经比较，差异无统计学意义（P> 0.05）。结论 罗哌卡因与左布比卡因用于锁骨上臂丛神经阻滞均可达到良好的镇痛与麻醉效果，但罗哌卡因的膈肌麻痹率更低且具有更好的术后镇痛效果。

AIM To investigate the effects of angle pocket injection of ropivacaine and levobupivacaine on diaphragm function and expression of postoperative pain mediators in patients with supraclavicular brachial plexus block(SCBPB). METHODS A total of 80 SCBPB patients in hospital from January 2020 to June 2021 were selected as the research subjects, and were divided into 2 groups according to the random number table method, with 40 patients in each group. The control group was given levobupivacaine corner pocket injection, and the observation group was given ropivacaine corner pocket injection. The nerve block, postoperative analgesic pump and sufentanil use, diaphragm paralysis, adverse reactions, and myocardial indicators [serum troponin(CTnI), creatine kinase isoenzyme(CK-MB)]were observed and compared in 2 groups. RESULTS The onset time of sensory block and motor block in the observation group was longer than that in the control group, and the duration of sensory block and motor block was shorter than that in the control group, and the difference was statistically significant(P < 0.05). There was no significant difference in the success rate of block(P > 0.05). The time of first pressing the analgesic pump after operation in the observation group was shorter than that in the control group, and the difference was statistically significant(P < 0.05). The total rate of diaphragmatic paralysis after 30 min of arrest was lower than that in the control group(P < 0.05). The serum CTnI and CK-MB levels of the observation group were lower than those of the control group at 24 h after administration, and the difference was statistically significant(P < 0.05). The difference in the incidence of adverse reactions between 2 groups was not statistically significant(P > 0.05). CONCLUSION Ropivacaine and levobupivacaine used for supraclavicular brachial plexus block can achieve good analgesia and anesthesia, but ropivacaine has a lower rate of diaphragmatic paralysis and better postoperative analgesia.