前臂正中神经阻滞麻醉对桡动脉血流动力学和穿刺置管成功率的影响  

Effects of median nerve block in forearm on hemodynamics of radial artery and success rate of cannulation

作　　者：李光才[1] 杨银燕[1] 黄同飞 姚军[2] LI Guangcai YANG Yinyan HUANG Tongfei YAO Jun(Department of Anesthesiology, Guizhou Aerospace Hospital, Zunyi 563000, Guizhou , Chin)

机构地区：[1]贵州航天医院麻醉科,贵州遵义563000 [2]上海交通大学附属第六人民医院麻醉科

出　　处：《上海医学》2016年第10期599-602,F0003,共5页Shanghai Medical Journal

摘　　要：目的应用彩色多普勒超声技术评估前臂正中神经阻滞麻醉对桡动脉内径、收缩期峰值血流速度(VP)、阻力指数(RI)的影响,以及该方法对桡动脉穿刺置管成功率的影响。方法选择术中需行动脉有创血压监测的患者60例,将其随机分入研究组(在正中神经阻滞麻醉后行桡动脉穿刺)和对照组(直接行桡动脉穿刺),每组30例。研究组在超声引导下于前臂中点注射1%利多卡因5 m L进行正中神经阻滞麻醉,在阻滞前5 min和阻滞后5、10 min 3个时间点,应用超声于离桡骨茎突近端1 cm处短轴平面测量桡动脉内径;在长轴平面当彩色多普勒显示血流充盈整个管腔时取得脉冲多普勒频谱,测量VP和RI。桡动脉穿刺部位均为桡骨茎突内侧触摸动脉搏动最明显处,用20G套管针采用触诊穿刺法进行桡动脉穿刺置管。记录两组患者首次穿刺成功率、最终穿刺成功率、穿刺次数和穿刺时间。结果研究组患者在超声引导下均成功完成正中神经阻滞麻醉,与阻滞前5 min相比,阻滞后5和10 min桡动脉的VP均显著加快(P值均<0.05),RI均显著降低(P值均<0.05);阻滞后5 min与阻滞后10 min相比,桡动脉的VP和RI的差异均无统计学意义(P值均>0.05);阻滞前后各时间点桡动脉内径的差异均无统计学意义(P值均>0.05)。研究组的首次穿刺成功率显著高于对照组(P<0.05),平均穿刺次数显著少于对照组(P<0.05),平均穿刺时间显著短于对照组(P<0.05)。两组间最终穿刺成功率的差异无统计学意义(P>0.05)。结论前臂正中神经阻滞麻醉能显著增加桡动脉的VP,降低RI,提高首次穿刺成功率,减少平均穿刺次数,缩短平均穿刺时间,使操作者能更高效地对桡动脉进行穿刺置管。Objective To investigate the influence of median nerve block in forearm on the hemodynamic changes of radial artery by color doppler velocity tracing and on the success rate of cannulation. Methods Sixty patients who required invasive blood pressure monitoring during surgery were randomized into control group and study group （n = 30）. Under ultrasound guidance, median nerve block in forearm was operated by an injection of 1% lidocaine （5 mL） in the study group before induction of anesthesia. Radial artery diameter was measured in vertical planes （1 cm proximal to the styloid process） using a SonoSite Ultrasound System 5 min before block, and 5 minutes and 10 minutes after block. Meanwhile, the peak velocity and resistance index were measured at long axis plane when the highest waveforms was seen. Radial artery cannulation was performed by touch palpation at interior styloid process where the strongest pulse could be touched. Control group received routine radial artery cannulation by touch palpation without median nerve block. The catheterization success rate, number of puncture and catheterization time were recorded. Results Median nerve block in forearm was successfully done in all the 30 patients in study group. Compared with those at 5 minutes before block, the peak velocities were significantly increased at 5 minutes and 10 minutes after block （both P〈0. 05）, while resistance index were significantly decreased （both P〈0. 05）. The peak velocity and resistance index at 5 minutes after block were not statisticallydifferent from those at 10 minutes after block （both P〉0. 05）. There were no significant differences in the diameter of mean radial artery at any time points （all P〉O. 05）. The first-attempt success rate of cannulation in study group was significantly higher than that in control group （P〈0.05）, while the total catheterization time and the number of puncture in study group were significantly lower than those in control group （both P〈O. 05）. There was no si

关 键 词：彩色多普勒超声 正中神经阻滞 桡动脉置管 血流动力学 

分 类 号：R614[医药卫生—麻醉学]