神经刺激器引导下多点臂丛神经阻滞在高龄患者前臂手术中的应用  

Brachial Plexus Block Guided by Multiple Nerve Stimulation Used in the Patients of Advanced Age Undergoing Forearm Surgeries

作　　者：付建强[1] 谢长春[1] 黄建辉[1] 孙超君[1] 钟启钊[1] 陈旭[1] 

机构地区：[1]广州医学院荔湾医院麻醉科,广东广州510170

出　　处：《临床医学工程》2010年第2期19-21,共3页Clinical Medicine & Engineering

摘　　要：目的比较神经刺激器引导下行多点腋路臂丛神经阻滞与传统腋路臂丛神经阻滞和全身麻醉在高龄患者前臂手术中的麻醉效果和安全性。方法60例择期行前臂及手部手术的高龄患者随机均分为A、B、C三组。A组在神经刺激器引导下行分别阻滞肌皮神经、正中神经、尺神经和桡神经,局麻药选用0.25%罗哌卡因各5～6ml;B组行单纯腋路臂丛神经阻滞,注射0.25%罗哌卡因20～25ml;C组行插管全身麻醉。记录患者平均动脉压、麻醉相关数据。结果B组VAS评分明显高于A组(P<0.01);C组T1、T2、T3时间点与T0MAP比较有明显降低(P<0.05、P<0.01、P<0.01);C组在T1、T3时间点的MAP、镇痛时间、在室时间、术后送ICU患者比例均与A、B组有显著差异。结论采用神经刺激器引导下行多点臂丛神经阻滞用于高龄患者前臂手术成功率高,安全、麻醉并发症少。Objective To compare the clinical outcomes of axillary brachial plexus block guided by multiple nerve stimulator with conventional technique and the general anesthesia used in the patients of advanced age undergoing forearm surgeries. Methods Sixty patients of advanced age undergoing forearm or hand surgeries were divided into three groups randomly with 20 patients in each group： Group A were received axillary brachial plexus block guided by multiple nerve stimulator and 5 - 6 ml 0.25% ropivacaine for each nerve territories （musculo-cutaneous,radial,median and ulnar） respectively, Group B were received axillary brachial plexus block with conventional single injective technique and 20 - 25 ml 0.25% ropivacaine, Group C were received the general anesthesia. MAP and anesthesia-related data were recorded. Results The VAS of group A were less than that of the group B（P〈0.01）. MAP of group C decreased dramatically at T1, T2, T3 compared to MAP at To （P〈0.05, P〈0.01, P〈0.01）. Group C had significant difference compare to group A and B in the values of MAP at T1 and T3, the time of painless, the time in operation room, the proportion of ICU. Conclusion It is effective for axillary brachial plexus block guided by multiple nerve stimulator used in the patients of advanced age undergoing forearm surgeries with higher success rate, safety and less side effects.

关 键 词：神经刺激器 高龄病人 前臂手术 臂丛神经阻滞 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]