改良喙突入路与经典喙突入路定位对锁骨下臂丛神经阻滞的影响对比  

Comparison of the effects between the modified and classic coracoid approach in infraclavicular brachial plexus nerve block

作　　者：曹淑梅[1] 李莎莎[1] 卢荣军[1] 续蕾[1] 

机构地区：[1]西安市第一医院麻醉科,710002

出　　处：《中国医师进修杂志》2014年第32期38-40,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨改良喙突入路和经典喙突入路定位对锁骨下臂丛神经阻滞的影响。方法对60例择期行臂丛神经阻滞手术的患者，按随机数字表法分为观察组（采用神经刺激器定位臂丛神经）和对照组，每组30例。对照组以喙突内下2cm为穿刺点，观察组穿刺点参考喙突内下2cm，并用臂丛神经体表的投影对该穿刺点进行改良。记录两组操作时间、穿刺次数、阻滞成功率、并发症及患者的24h麻醉满意度。结果观察组操作时间明显少于对照组[（3．2±1．1）min比（4．3±1．4）min]（P〈0．05），且观察组一次穿刺定位到神经的比率明显高于对照组[73．3％（22／30）比50．0％（15／30）]（P〈0．05）。两组阻滞成功率、并发症及患者的24h麻醉满意度比较差异无统计学意义（P〉0．05）。结论改良喙突入路可以明显提高单次穿刺定位到神经的概率，且可减少操作时间，提高了穿刺点体表定位的准确性。Objective To investigate the effects between the modified and classic coracoid approach in infraclavicular brachial plexus nerve block. Methods Sixty patients scheduled for elective surgical procedures under infraclavicular brachial plexus block were divided into observation group and control group by table of random digit method with 30 cases each. The puncture point of control group was approach via the point 2 cm medial and caudal to the coracoid process. The puncture point of observation group was modified by surface projection of the brachial plexus. Peripheral nerve stimulator was used to confirm the proper localization of the plexus. The performance time, number of puncture, anesthesia success rate, incidence of complications and 24 h patient satisfaction were recorded. Results The performance time in observation group was less than that in control group [（3.2 ± 1.1） min vs.（4.3 ± 1.4） mini （P〈 0.05）. The chance of locating the brachial plexus in a single puncture without adjusting the block needle in observation group was significantly higher than that in control group [73.3%（22/30） vs. 50.0%（15/30） ] （P 〈 0.05 ）. There were no statistical differences in anesthesia success rate,incidence of complications and 24 h patient satisfaction between two groups （P 〉 0.05 ）. Conclusions The modified coracoid approach can significantly improve the probability of locating the nerve in one puncture that reduces the performance time. It can improve the accuracy of puncture point position on the body surface.

关 键 词：神经传导阻滞 臂丛 喙突入路 周围神经刺激器 

分 类 号：R614[医药卫生—麻醉学] R687.3[医药卫生—外科学]