神经刺激仪引导喙突旁入路臂丛神经阻滞在上肢手术中的临床效果观察  

Clinical effect observation of nerve stimulator guided coracoid approach next to the brachial plexus block in upper extremity surgery

作　　者：何文胜[1] 祖玲洁 杨晓春[1] 孙海军[1] 吴振宇[1] HE Wen-sheng ZU Ling-jie YANG Xiao-chun SUN Hai-jun WU Zhen-yu(Department of Anesthesiology, the First Hospital of Qinhuan gdao City, Hebei Province, Qinhuan gdao 066000,China Department of Family Planning, Maternal and Child Health Care Hospital of Qinhuangdao City, Hebei Province, Qinhuan gdao 066000, China)

机构地区：[1]河北省秦皇岛市第一医院麻醉科,河北秦皇岛066000 [2]河北省秦皇岛市妇幼保健院计划生育科,河北秦皇岛066000

出　　处：《河北医科大学学报》2017年第8期933-936,共4页Journal of Hebei Medical University

摘　　要：目的观察神经刺激仪引导下的喙突旁入路臂丛神经阻滞在上肢手术中的临床效果。方法80例ASA分级为Ⅰ~Ⅱ级,拟行上肢肘关节、前臂、腕关节或手部手术的患者,随机分为喙突旁入路组(A组)和腋入路组(B组),每组40例。实施神经刺激仪引导的臂丛神经阻滞,分别采用喙突旁入路和腋入路。定位成功后注入0.375%罗哌卡因40mL。注射药物完毕后每隔5min测试臂丛在前臂终末神经的感觉阻滞情况和运动阻滞情况,并记录操作时间、有效率和并发症发生情况。结果 2组手术持续时间和操作时间差异无统计学意义(P>0.05)。A组正中神经、肌皮神经和总体感觉阻滞起效时间短于B组(P<0.05);2组尺神经、桡神经、前臂内侧皮神经感觉阻滞起效时间差异无统计学意义(P>0.05)。A组正中神经、总体运动阻滞起效时间短于B组(P<0.05);2组尺神经和桡神经运动阻滞起效时间差异无统计学意义(P>0.05)。A组阻滞成功率高于B组(P<0.05),止血带疼痛发生率低于B组((P<0.05))。结论神经刺激仪引导喙突旁入路臂丛神经阻滞操作简单安全,起效时间快,阻滞效果好;喙突旁入路臂丛神经阻滞具有良好的临床应用意义。Objective To observe the clinical effect of coraeoid approach brachial plexus block for upper extremity surgery by using a nerve stimulator. Methods Eighty patients ASA class Ⅰ - Ⅱ scheduled for surgery in elbow, forearm, wrist or hand were randomly divided into two group： coracoid approach group（group A） and axillary approach group（group B）, 40 patients in each group. All cases were carried out coracoid approach or axillary brachial plexus block using a nerve stimulator. 40 mL 0.375% ropivacaine was injected after successful localization. Sensory block and motor block was evaluated every 5 minutes after the end of injection of the local anesthetic. The processing time required to complete the block, success rate and complications were also tanked notes. Results There was no significant difference between the two groups in duration of operation and processing time for block（P〉0.05）. The onset time of sensory block for median nerve, musculocutaneous nerve and onset time of global sensory block in group A were significantly shorter than that in group B（P〈0.05）. The onset time of sensory block for ulnar nerve, radial nerve and medial antebrachial cutaneous nerve in the two groups had no significant difference（P〉0.05）. The onset time of motor block for median nerveand onset time of global motor block in group A were significantly shorter than that in group B（P〈0.05）. The onset time of motor block for ulnar nerve and radial nerve in the two groups had no significant difference（P〉0.05）. The rate of successful block in group A was Significantly higher than that in group B（P〈0.05）, and the rate of tourniquet pain in group A was significantly lower than that in group B（P〈0.05）. Conclusion Coracoid approach brachial plexus block is simple and safe guided by nerve stimulator. It requires shorter onset times and produces more perfect anesthesia effect. It is an favorable approach of brachial plexus block.

关 键 词：神经传导阻滞 臂丛 上肢 外科手术 

分 类 号：R614.4[医药卫生—麻醉学]