双侧腋路臂丛神经阻滞用于双上肢显微外科术中的探索研究  

Anesthetic efficacy and safety of bilateral axillary brachial plexus block in microsurgery for bilateral upper limbs

作　　者：曲彦亮[1] 申恒花[2] 温宝磊[1] 武春敏[1] 张立新[1] 王德明[1] 张元信[1] 侯书健[1] 张欣[1] 马超[1] 刘春燕[1] 

机构地区：[1]解放军第401医院全军手外科中心,山东青岛266071 [2]青岛市第八人民医院麻醉科,山东青岛266071

出　　处：《第三军医大学学报》2016年第22期2457-2461,共5页Journal of Third Military Medical University

基　　金：济南军区后勤科研项目(CJN15J013)~~

摘　　要：目的 探索研究双侧腋路臂丛神经阻滞用于双上肢显微外科术中的麻醉效果及安全性。方法 双上肢显微外科手术患者80例,ASA分级Ⅰ-Ⅱ级,采用随机数字表达分为两组,每组40例,臂丛组在神经刺激仪下行双侧腋路臂丛神经阻滞,全麻组采用气管插管静吸复合全身麻醉。比较两组患者麻醉前（T1）、麻醉完成时（T2）,手术开始时（T3）、手术结束时（T4）的生命体征;术后2、4、8、12 h疼痛程度;术后疼痛感知时间,麻醉费用,不良反应以及术者和患者麻醉满意度。结果 血压、心率全麻组内T1时明显低于T4时（P〈0.05）,组间T4时臂丛组明显低于全麻组（P〈0.05）;术后2、4、8 h疼痛VAS评分臂丛组明显低于全麻组（P〈0.05）;术后疼痛感知时间臂丛组明显长于全麻组（P〈0.05）,麻醉费用臂丛组明显低于全麻组（P〈0.05）,不良反应发生率臂丛组明显低于全麻组（P〈0.05）;术者和患者的麻醉满意度臂丛组明显高于全麻组（P〈0.05）。结论 双侧腋路臂丛神经阻滞适合双上肢显微外科手术。Objective To observe the clinical effects and safety of bilateral axillary brachial plexus block in microsurgery for bilateral upper limbs. Methods In this randomized controlled trial, 80 patients classified to ASA grade Ⅰ or Ⅱ physical status were randomly allocated to 2 groups, i. e. , general anesthesia and bilateral brachial plexus block, for upper limb microsurgery. Each group contained 40 patients. In brachial plexus group, bilateral axillary brachial plexus block was carried out under the instruction of NerveStimulator, while Intravenous-inhalation Combined Anesthesia was used in general anesthesia group. Vital signs were assessed before anesthesia （T1 ） and after anesthesia （T2 ）, as well as before surgery （T3 ） and after surgery （T4）. Pain status was scored at 2, 4, 8 and 12 h after surgery. Adverse events as well as satisfaction in anesthesia and anesthesia fees were assessed. pressure （BP） and heart rate （HR） were significantly lower Results In general anesthesia group, systolic at T1 versus at T4 （P 〈 0. 05）. At T4, they weresignificantly higher than brachial plexus group （ P 〈 0.05 ）. The VAS score of postoperative 2, 4 and 8 h showed that patients in general anesthesia suffered more pain compared to patients in brachial plexus group （ P 〈 0. 05 ）. However, the postoperative pain period was significantly longer in brachial plexus group than in general anesthesia group （ P 〈 0. 05 ）. In addition, the cost of general anesthesia was significantly highercompared to brachial plexus group, associated with higher incidence of adverse events but less patientsatisfaction （P 〈 0.05）. Conclusion Bilateral axillary brachial plexus block is suitable under the operationof bilateral upper limb microsurgery.

关 键 词：双侧腋路臂丛神经阻滞 全身麻醉 双上肢 显微外科手术 

分 类 号：R614.4[医药卫生—麻醉学] R616.2[医药卫生—外科学]