腋路臂丛3种神经定位方法阻滞效果的比较  

A comparison of three nerve-localization techniques on axillary brachial plexus block

作　　者：王德明[1] 侯书健[2] 张元信[1] 屈志刚[2] 孙乐天[2] 何旭[2] 

机构地区：[1]解放军第401医院济南军区麻醉中心 [2]解放军第401医院全军手外科中心,山东青岛266071

出　　处：《中国临床解剖学杂志》2013年第2期220-224,共5页Chinese Journal of Clinical Anatomy

摘　　要：目的采用随机对照的方法对变体位、变角度两点法、传统一点法、神经刺激器法这3种定位方法应用于腋路臂丛阻滞的效果进行比较。方法 75例拟行前臂和手部手术的病人被随机分为变体位、变角度两点法定位组(VTP组);传统的腋动脉旁一点法定位组(TOP组);周围神经刺激器定位组(PNS组),每组25例。局麻药皆用0.375%盐酸罗哌卡因45 ml进行腋路臂丛阻滞,阻滞后观察对肘部远端5支神经支配区域的感觉和运动阻滞效果,比较3组在臂丛阻滞成功率、时效等方面的差异。结果 VTP组、PNS组的阻滞成功率高于TOP组(96%、100%对72%,P<0.01);VTP组和PNS组的麻醉起效时间(T2)短于TOP组(P<0.01);VTP组手术等待时间(T3)短于TOP组和PNS组(P<0.05);PNS组操作时间(T1)长于TOP组、VTP组(P<0.05)。结论变体位、变角度两点法腋路臂丛阻滞是一种良好的阻滞方法,弥补了传统一点法的不足,能给手和前臂手术提供快捷、简单、有效又相对经济的麻醉。Objective To compare the clinical effect of axillary brachial plexus block performed by using three methods of nerve localization： variable posture and angle two-point method, the traditional one point method and peripheral nerve stimulation method. Methods Seventy-five emergency patients （ASA Ⅰ- Ⅱ ） undergoing the forearm and hand surgery were selected and randomly divided into three groups （n=25）：the variable posture and angle two-point method group （VTP） and the traditional one point method group （TOP） and peripheral nerve stimulator group （PNS） . Axillary brachial plexus block was performed with 45 ml of 0.375% ropivacaine in three groups. Success was defined as a sensory block of 5 nerves （median nerve, ulnar nerve, radial nerve, musculocutaneous nerve, medial brachial cutaneous nerve） with territories distal to the elbow 20 minutes after performing the block. The block success rate, onset time of analgesia, tourniquet tolerance and occurrence of complication were compared in three groups. Results The success rate of group VTP and PNS was higher than that of group TOP （96.0%,100% vs72.0%,P〈0.01）.The success rate of blocking of the radial and the musculocutaneous nerves in group VTP and PNS was obviously higher than that in group TOP （ P〈0.05）.Onset time （T2） of group VTP and PNS was shorter than that of group TOP. Time to achieve readiness for surgery （T3） was shorter in group VTP than that in group TOP and PNS （P〈0.05）; Performance time（T1） of group PNS was longer than that of group TOP and PNS. Conclusions The technique of VTP is a good block method to make up for the shortcomings of the traditional one point method .Its advantage is a better block the radial and the musculocutaneous nerves and reduction of patients＇ discomfort caused by tourniquet. It can provide for hands and forearms operation a fast, simple, effective and relatively affordable anesthesia.

关 键 词：神经阻滞 臂丛 腋部 变体位 变角度两点法 传统一点法 神经刺激器 

分 类 号：R614.4[医药卫生—麻醉学]