天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (7): 654-656.doi: 10.11958/20193828

• 临床研究 • 上一篇    下一篇

罗哌卡因用于超声引导老年腹股沟疝患者髂腹下、髂 腹股沟联合生殖股神经阻滞的EC50及EC95

孙熠，王海云，华伟△，赵茗姝   

  1. 天津医科大学三中心临床学院、天津市第三中心医院麻醉科（邮编 300170）
  • 收稿日期:2019-12-19 修回日期:2020-03-17 出版日期:2020-07-15 发布日期:2020-07-16
  • 作者简介:孙熠（1983），男，硕士，主治医师，主要从事麻醉镇痛方面研究

EC50 and EC95 of ropivacaine for ultrasound-guided llioinguinal, lliohypogastric and genitocrural nerve block in aged patients with inguinal hernia

SUN Yi, WANG Hai-yun, HUA Wei△, ZHAO Ming-shu   

  1. Department of Anesthesiology, the Third Central Clinical College of Tianjin Medical University, the Third Central Hospital of Tianjin, Tianjin 300170, China
  • Received:2019-12-19 Revised:2020-03-17 Published:2020-07-15 Online:2020-07-16

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摘要： 目的 确定罗哌卡因用于超声引导下老年腹股沟疝患者髂腹下、髂腹股沟联合生殖股神经阻滞的半数有 效浓度（EC50）及95%有效浓度（EC95）。方法 择期行单侧腹股沟疝无张力修补术男性患者35例，美国麻醉医师协会 （ASA）分级Ⅱ～Ⅲ级，体质量指数19~27 kg/m2 ，年龄65~79岁。在超声引导下行髂腹下、髂腹股沟联合生殖股神经阻 滞，定位成功后，每个穿刺点注射罗哌卡因10 mL。手术开始前采用针刺法评价神经支配区域感觉阻滞情况，将手术 开始前目标神经皮肤分布区均无痛觉即视觉模拟评分（VAS）=0分作为阻滞有效的标准。罗哌卡因浓度按Dixon序 贯法确定，初始浓度为0.3%，阻滞有效时，下一例患者采用低一级浓度，反之，采用高一级浓度，相邻浓度的比值为1∶ 1.1。采用Probit概率单位回归分析法计算EC50、EC95及其95%可信区间（CI）。结果 35例患者中18例（51.4%）阻滞 成功，罗哌卡因EC50为0.263%（95%CI：0.248%~0.280%），EC95为0.348%（95%CI：0.323%~0.371%）。结论 超声引导 下髂腹下、髂腹股沟联合生殖股神经阻滞用于老年腹股沟疝手术时罗哌卡因的 EC50及 EC95分别为 0.263% 及 0.348%。

关键词: 神经传导阻滞；疝, 腹股沟；老年人；超声检查；剂量效应关系, 药物；罗哌卡因；生殖股神经

Abstract: Objective To determine the median effective concentration (EC50) and 95% effective concentration (EC95) of ropivacaine for ultrasound-guided llioinguinal, lliohypogastric and genitocruralnerve block in aged patients with inguinal hernia. Methods Thirty-five male patients, American Society of Anesthesiologists physical status Ⅱ or Ⅲ, body mass index 19-27 kg/m2 , aged 65-79 yr, scheduled for elective unilateral tension-free inguinal hernia repair were included in this study. Patients received an ultrasound-guided llioinguinal, lliohypogastric, and genitocrural nerve block. After successful location 10 mL ropivacaine was injected at each puncture point. The sensory block of the areas innervated by the nerves were assessed by pin-prick test. The painless of the areas innervated by target nerves (VAS=0) at the beginning of operation was regarded as the effective block. The concentration of ropivacaine was determined by Dixon up-and-down method. The initial concentration was 0.3%. When the block was effective, the next patient was given the low first-order concentration, on the contrary, the patient was given the high first-order concentration. The ratio between the adjacent concentrations was 1∶1.1. The EC50, EC95 and their 95% confidence interval (CI) were calculated by probit analysis. Results Eighteen (51.4%) in a total of 35 patients received a successful nerve block.The EC50 of ropivacaine was 0.263% (95%CI: 0.248%-0.280%) and the EC95 was 0.348% (95%CI: 0.323%-0.371%). Conclusion The EC50 and EC95 of ropivacaine for ultrasound-guided llioinguinal, lliohypogastric and genitocrural nerve block are 0.263% and 0.348% in aged patients with inguinal hernia respectively.

Key words: nerve block, hernia, inguinal, aged, ultrasonography, dose-response relationship, drug, ropivacaine; genitocruralnerve