增强超声引导对臂丛神经阻滞技术的影响  

Effect of enhanced ultrasound guiding on brachial plexus block

作　　者：戎玉兰[1] 李民[1] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《北京大学学报（医学版）》2012年第3期485-488,共4页Journal of Peking University:Health Sciences

摘　　要：目的:评价穿刺针增强显像技术在超声引导腋路臂丛神经阻滞中对穿刺针可视性的影响。方法:选择60例符合美国麻醉医师学会(American Society of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,拟于超声引导腋路臂丛神经阻滞下行手和/或前臂手术的患者,随机分为普通显像组(n=30)和增强显像组(n=30)。两组均通过超声(SonoSite M-Turbo)定位正中神经、尺神经、桡神经以及肌皮神经,增强显像组在进行穿刺时开启多波束增强技术按钮,两组通过刺激器引出特定运动后,在每支神经周围推注0.5%(质量分数)罗哌卡因10 mL,记录行臂丛神经阻滞过程中的操作时间、各支神经与皮肤表面的距离以及并发症,评价超声图像中穿刺针的可视性。结果:行腋路臂丛神经阻滞过程中,增强显像技术组较普通显像组操作时间短[(2.63±0.81)min vs.(5.07±1.89)min,P=0.01],且在行桡神经和肌皮神经阻滞时,增强显像技术组的穿刺针可视性更好(P<0.05)。结论:对位置较深的神经采用增强显像技术可提高穿刺针可视性并缩短操作时间。Objective：To assess whether the enhanced imaging technology can improve the needle visi- bility during ultrasound-guided auxiliary brachial plexus block. Methods： After obtaining informed con- sent, 60 ASA （American Society of Anesthesiologists） Ⅰ-Ⅱ patients undergoing forearm or hand sur- gery were enrolled in this prospective, randomized, double-blind study. The patients were randomly as- signed to two groups, the common image group （n = 30） and enhanced image group （n = 30）. Ultra- sound was used in guiding the block of the four branches of brachial plexus, i. e. the median, radial, ulnar and musculocutaneous nerves. In the enhanced image group a special function key ＂Multi-beam en- hance＂ （MBe） was turned on during the needle insertion. After the nerve stimulator identification of the median, radial, ulnar and musculocutaneous nerves, 10 mL of 0.5% ropivacaine was injected near each nerve. The operating time, the visibility of the needle, the depth of each nerve, the onset time of the block, and the complications related to the block were assessed and recorded. Results： The operating time was significantly shorter in the enhanced image group compared with the common image group [ （2.63±0.81 ） rain vs. （5.07 ± 1.89） rain, P =0.01 ]. The visibility of the needle was better in en- hanced image group when the radial and musculocutaneous nerve blocks were performed （ P 〈 0.05 ）. Conclusion： The enhanced image technology can reduce the operating time and improve the visibility of the needle during the peripheral nerve block for the nerve which is relatively deep.

关 键 词：超声学 臂丛 神经阻滞 图像增强 

分 类 号：R614.4[医药卫生—麻醉学]