神经刺激器定位下肌间沟置管连续臂丛神经阻滞的临床应用  

Clinical use of nerve stimulator located cathetering for continuous interscalene brachial plexus block

作　　者：李振威[1] 廖荣宗[1] 区锦燕[1] 罗富荣[1] 刘晓捷[1] 张诚章[1] 

机构地区：[1]佛山市中医院麻醉科,佛山528000

出　　处：《重庆医科大学学报》2009年第9期1270-1273,共4页Journal of Chongqing Medical University

基　　金：佛山市卫生局课题(2007093)

摘　　要：目的：研究神经刺激器定位下肌间沟置管行连续臂丛神经阻滞及术后镇痛的临床效果及可行性。方法：ASAⅠ-Ⅱ级的前臂、腕部或手部手术60例,随机等分成两组,Ⅰ组为对照组,采用传统盲探异感法定位和普通静脉留置针穿刺并置入硬外导管行连续臂丛神经阻滞和术后镇痛,Ⅱ组为实验组,采用神经刺激器定位和特制导管装置经肌间沟置管行连续臂丛神经阻滞和术后镇痛。结果：Ⅱ组麻醉操作时间、起效时间、感觉运动阻滞完善时间较Ⅰ组短,有显著性差异（P〈0.05）;Ⅱ组30例全部阻滞成功,Ⅰ组有3例尺侧阻滞不全,失败率10%;两组都取得较好的术后镇痛效果,但Ⅱ组效果更佳,两组有显著性差异（P〈0.05）,Ⅰ组出现导管穿刺处渗漏3例、导管部分脱出2例;Ⅱ组术中镇静药用量、术后镇痛局麻药用量较Ⅰ组少,有显著性差异（P〈0.05）;Ⅱ组30例均无出现并发症,Ⅰ组出现误穿血管并形成血肿4例、发生神经损伤4例。结论：神经刺激器定位下肌间沟置管行连续臂丛神经阻滞和术后镇痛成功率高、效果确切、不良反应少。Objectives：To study the clinical results and feasibility of continuous brachial plexus nerve block and postoperative anagesia with catheters located by nerve stimulator in interscalene approach. Methods：60 ASAⅠ-Ⅱ patients receiving continuous interscalene brachial plexus block and postoperative analgesia for forearm,wrist or hand surgery were randomized into two groups.In group I,nerve blocks were performed using a normal venous needle located with traditional method which elicites numbness of the limb. Then a epidural catheter was passed and secured. Group Ⅱ were guided by nerve stimulator and special catheters were placed. Results：Compared with group I,time to perform the block,time to block and time to obtain satisfactory sensory and motor blockade in group II were shorter（P〈0.05）.All cases were successful in group Ⅱ. There were 3 failure cases in group Ⅰ,with the failure rate of 10%. Postoperative analgesic results were good in two groups, but better in group Ⅱ（P〈0.05）. 3 analgesic leakage and 2 catheter dislocation arised in groupⅠ.Group Ⅱ had less intraoperative sedative usage and postoperative analgesics and local aneasthetics usage（P〈0.05）. 4 cases of hematoma and 4 cases of nerve injury occured in group I while no complication occured in group Ⅱ.Conclusions：Nerve stimulator-guided catheters for continuous brachial plexus nerve block and postoperative anagesia have a higher success rate, more accurate results,and less adverse reactions.

关 键 词：神经刺激器 留置导管 臂丛神经阻滞 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]