超声引导下预注法在老年肥胖患者肌间沟阻滞中的应用  

作　　者：李振平[1] 袁孝忠[1] 陈炜[1] 孔敏[1] 

机构地区：[1]浙江省嘉兴市第一医院,312000

出　　处：《浙江临床医学》2017年第9期1722-1723,共2页Zhejiang Clinical Medical Journal

摘　　要：目的观察超声引导下预注法在老年肥胖患者肌间沟臂丛神经阻滞的效果。方法择期行上肢手术老年肥胖患者60例，ASAⅠ或Ⅱ级，BMI≥26kg／m^2，年龄≥65岁，随机均分成预注组（Y组）和非预注组（F组），每组各30例。均在超声引导下行肌间沟臂丛神经阻滞：Y组在可见的臂丛神经干附近预先注入半量局麻药，约2min后，再在新发现的臂丛神经干附近注入余下局麻药；F组在可见的臂丛神经干附近注入全量局麻药。记录两组的操作时间、感觉阻滞起效时间；评价桡神经、尺神经及正中神经支配区域的感觉阻滞完善程度；观察并记录并发症。结果Y组完成操作所需时间略长于F组，差异无统计学意义（P〉0．05）；Y组感觉阻滞起效时间短于F组，两组差异有统计学意义（P〈0．05）；Y组正中神经及尺神经阻滞完善率均明显高于F组LP〈0．05）。两纽均无并发症发生。结论超声引下肌间沟预注法，可显著提高老年肥胖患者神经阻滞的完善率，并缩短阻滞起效时间。Objective To investigate the role of interscalene brachial plexus block ultrasound-guided with priming principle in elderly obese patients. Methods Sixty patients scheduled upper extremity surgeries under brachial plexus anesthesia were allocated into 2 groups （ Y and F, each 30 patients ） randomly which were maintained with 30ml of 0.375% ropivacaine in intersealene brachial plexus block by ultrasound guided.Group Y were injected with half dose of local anesthetic around to the visible hrachial plexus previously and the residual anesthetic around to the discovered brachial plexus newly about two minutes later. Group F were injected with all the local anesthetic directly around to the visible brachial plexus.The operation time and the onset time were recorded. The anesthetic effect of surgical field and the perfect degree of sensory blockade in the region dominated by radial nerve, ulnar nerve and median nerve were both assessed. The complications were observed and recorded as wellResults Group Y was slightly longer than group F about the time needed to complete the operation, but there was no statistically significant difference （ P〉0.05 ） . The sensory nerve block onset time of group Y was shorter than that of group F, the difference was statistically significant （ P〈0.05 ） .The improvement rate of median nerve and ulnar nerve block in group Y was significantly higher than that in group F （ P〈0.05 ） .There were no complications in both groups. Conclusion The method of interscalene brachial plexus block ultrasound-guided with preliminary injection can significantly improve the rate of nerve block and shorten the onset time of block in elderly obese patients.

关 键 词：超声引导 预注 臂丛神经阻滞 肥胖 

分 类 号：R614.4[医药卫生—麻醉学]