超声引导锁骨手术患者C5和颈浅丛联合阻滞的效果  

Efficacy of ultrasound-guided combined Cs and superficial cervical plexus block in patients undergoing clav- icle surgery

作　　者：傅志海[1] 吴雅松[1] 王小虎[1] 倪勇[2] 王琛[2] 

机构地区：[1]厦门市第三医院麻醉科,361100 [2]苏州大学附属第二医院麻醉科

出　　处：《中华麻醉学杂志》2013年第11期1380-1382,共3页Chinese Journal of Anesthesiology

基　　金：福建省卫生厅青年科研项目（2012291）;厦门市卫生局资助研究经费

摘　　要：目的评价超声引导锁骨手术患者C5和颈浅丛联合阻滞的效果。方法择期拟行锁骨骨折切开复位钢板螺丝钉内固定术患者60例，性别不限，年龄18—64岁，体重指数17．3～27．6kg／m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n=30）：超声引导组（U组）在C，臂丛神经图像的周围注射10ml局麻药，穿刺针越过C5臂丛神经在胸锁乳突肌下缘再次注射10ml局麻药。解剖手法定位组（A组）在前、中斜角肌之间的肌间沟行臂丛神经阻滞，注射10m1局麻药，拔出穿刺针在胸锁乳突肌后缘中点再注射10ml局麻药。局麻药为0．375％左布比卡因和1％利多卡因的混合液。记录操作时间，锁骨内侧缘、锁骨中点、锁骨外侧缘痛觉消失时间及镇痛时间；评价手术过程中的麻醉效果满意度，观察相关并发症的发生情况。结果与A组比较，u组操作时间延长，锁骨外侧缘、锁骨中点区域痛觉消失时间缩短，麻醉效果满意率升高，镇痛时间延长（P〈0．05）。A组刺破血管3例，轻度局麻药中毒1例，U组无相关并发症发生。结论与解剖手法定位比较，超声引导下C5和颈浅丛联合阻滞的麻醉效果较好，对锁骨外侧缘、锁骨中点区域起效快，镇痛时间较长和相关并发症较少。Objective To evaluate the efficacy of ultrasound-guided combined Cs and superficial cervical plexus block in patients undergoing clavicle surgery. Methods Sixty ASA physical status Ⅰ or Ⅱ patients, scheduled for elective clavicle surgery, were randomly divided into 2 groups （ n = 30 each） using a random number table： injection with 10 ml local anesthetic guided by ultrasound group （group U）, and injection with 10 ml local anesthetic guided by anatomical landmark group （group A）. A mixture of 0. 375 % levobupivacaine and 1.0 % li- docaine was used. The time spent performing the block onset time of analgesia, onset time of analgesia in the me- dial border, midpoint and lateral border of the clavicle and duration of analgesia were measured. The effectiveness of block （excellent, good, failure） was assessed. The complications were observed. Results Compared with group A, the time spent performing the block was significantly prolonged, the onset time of analgesia in the lateral border and midpoint of the clavicle was shortened, the rate of excellent anesthesia was increased, and the duration of analgesia was prolonged in group U （ P 〈 0.05）. No complications occurred in group U, while vascular punc- ture occurred in 3 cases, and one patient developed mild toxic reaction in group A. Conclusion Ultrasound-guid- ed combined Cs and superficial cervical plexus block provides better block, with faster onset time of analgesia in the lateral border and midpoint of the clavicle, longer duration of analgesia and fewer complications as compared with that guided by anatomical landmarks in patients undergoing clavicle surgery.

关 键 词：超声检查 锁骨 臂丛 颈丛 神经传导阻滞 

分 类 号：R614[医药卫生—麻醉学]