神经刺激器定位肌间沟臂丛神经干阻滞临床效果观察  

Clinical study on interscalene brachial plexus block by peripheral nerve stimulator

作　　者：陈文东[1] 徐韶怡[1] 杨南 

机构地区：[1]浙江省温州市中医院麻醉科,325000 [2]温州市华东手足外科医院麻醉科

出　　处：《中国医师进修杂志》2007年第3期18-20,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 比较在外周神经刺激器（PNS）引导下，常规定位方法和神经干定位方法，应用于肌间沟臂丛神经阻滞对尺侧神经阻滞成功率的影响。方法选择实施臂丛神经阻滞的上肢手术患者100例，随机平均分为两组。在PNS引导下，Ⅰ组患者只要刺激到神经，引发肌肉收缩，即给予阻滞。Ⅱ组患者在刺激到臂丛神经上、中、下干，并引出提肩、前臂外展、前臂内收等动作分别给予阻滞。两组局麻药均使用0．5％罗哌卡因20ml。结果Ⅰ、Ⅱ组对尺神经及前臂内侧皮神经阻滞有效率分别为82％（41例）、80％（40例）和98％（49例）、98％（49例），Ⅱ组显著高于Ⅰ组（P〈0．05）。结论 PNS引导下的肌间沟臂丛神经干定位方法比常规定位方法更精确，使局麻药液在肌间沟臂丛神经鞘内分布更趋于合理，可提高对尺侧神经阻滞的有效率。Objective To compare the success rate of dorso-ulnar nerve block using nerve trunk method with traditional method that both be guided by peripheral nerve stimulator （PNS）. Methods One hundred patients undergoing surgery of the upper limb were randomly assigned to two groups with 50 cases each.In group 1,20 ml of 0.5% ropivacaine was injected after locating the nerve and muscle contraction. In group Ⅱ, once twitching was observed,7 ml of 0.5% ropivacaine was injected on shoulder lift,7 ml on forearm abduction and 6 ml on forearm adduction. Results The success cases and rate of ulnar nerve and medial cutaneous nerve of forearm block were 41 （82%）,40（80%）and 49（98%）,49（98%） cases.The group Ⅱ was greater than group I in the success rate of dorso-ulnar nerve block （P 〈 0.05）. Conclusions The nerve trunk method by PNS is more precise than the traditional method on interscalene brachial plexus block, moreover the distribution of local anesthetic is more reasonable in interscalene bmchial plexus. The success rate of dorso-ulnar nerve block will be improved by this method.

关 键 词：外周神经刺激器 臂丛阻滞 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]