臂丛神经阻滞对前臂远端尺、桡动脉血流动力学参数的影响  

Effect of Brachial Plexus Block on Hemodynamic Changes of Ulnar Artery and Radial Artery at Distal Forearm

作　　者：李挺[1] 南洋[1] 高伟阳[2] 叶仙华[1] 施通[1] 叶琦刚[1] 马剑峰[1] 李军[1] 

机构地区：[1]温州医学院附属第二医院麻醉科,325027 [2]温州医学院附属第二医院手外科,325027

出　　处：《医学研究杂志》2013年第4期67-70,共4页Journal of Medical Research

基　　金：浙江省卫生厅科研基金资助项目(2009A145)

摘　　要：目的采用脉冲多普勒超声仪,评估臂丛神经阻滞对上述动脉血流或Ⅱ级。方法在超声引导下完成臂丛神经阻滞。局麻药为2%利多卡因与0.75%罗哌卡因等量混合液,共20ml。注药30min后,肌皮神经、桡神经、正中神经、尺神经均被完全阻滞,入选该病例,否则排除该病例。采用脉冲多普勒超声仪测量神经阻滞前及阻滞后30min尺、桡动脉的血流动力学参数:收缩期峰速度(PSV)、舒张末期速度(EDV)、平均速度(TAMAX)、搏动指数(PI)、阻力指数(RI)、血管横截面积(area)及血流量(Q)。结果 35例患者臂丛神经的阻滞效果达到了入选标准。与各自的基础值比较,尺动脉和桡动脉阻滞后的PSV、EDV和TAMAX增快(P<0.01),area和Q均增大(P<0.01),PI和RI降低(P<0.01)。与桡动脉比较,尺动脉阻滞前的area较小(P<0.01),Q较低(P<0.05),EDV较高(P<0.05);阻滞后尺动脉的EDV仍高于桡动脉(P<0.05),两动脉的其他血流动力学参数比较,均无统计学差异(P>0.05)。尺、桡动脉TAMAX的相对比均大于各自的EDV(P<0.05)、PSV(P<0.01)和area(P<0.01)。与桡动脉比较,尺动脉的area相对比和Q相对比较大(P<0.01和P<0.05)。结论臂丛神经阻滞可显著扩张尺桡动脉、降低血管阻力、增加血流速度和血流量;对尺动脉的影响程度大于桡动脉。Objective To evaluate the effect of brachial plexus block（BPB） on regional hemodynamic changes of upper extremity by pulsed - wave Doppler （PWD） ultrasound. Methods Patients ASA I - ll scheduled for upper extremity operation were assigned to re- ceive a supraclavicular brachial plexus block guided by ultrasound with 20ml mixture of equal volumes of 2% lidocaine and 0.75% ropiva- caine. The intensity of sensory block of musculocutaneous, redial, median and ulnar was measured 30 minutes after the block. Patients with complete block （ absence of pain in the peripheral sensory distributions of all four nerves） were included in this study. Patients with incomplete block （painful in at least one nerve） were excluded from the study. Regional hemodynamie parameters were measured in the ipsilateral ulnar artery and radial artery, using pulsed -wave Doppler （PWD） ultrasound, before the block and 30 rain after the block. Regional hemodynamic parameters included peak systolie velocity （PSV, cm/s） , end- diastolic velocity （El）V, cm/s） , time averaged maximum velocity （TAMAX, cm/s） , resistance index （RI）, pulsatility index （PI） and cross- sectional area （area, cm2）, Blood flow （Q） = TAMAX x area x 60s. Results Totally 35 patients with complete block were enrolled in the study. There was a significant in- crease in PSV, EDV, TAMAX, area, Q and a significant decrease in PI and RI of ulnar artery and radial artery 30min after BPB com- pared with the baseline（ P 〈0.01 ）. Compared with radial artery, Area （P 〈0.01 ） and Q （P 〈 0.05 ） of ulnar artery were smaller and EDV （ P 〈 0.05 ） of ulnar artery was higher before BPB. EDV of ulnar was still higher than that of radial artery after BPB （ P 〈 0.05 ）. The relative value of TAMAX was greater than that of EDV, PSV and area in both ulnar artery and radial artery. Compared with radial ar- tery, the relative value of Area and Q of ulnar artery were greater （P 〈 0.01 and P 〈 O. 05 ）. Conclusion Brach

关 键 词：超声检查 介入性 臂丛 神经传导阻滞 血流动力学 前臂 

分 类 号：R614.4[医药卫生—麻醉学]