超声引导下正中神经阻滞对腕管综合征治疗效果的影响  

Effect of ultrasound-guided median nerve block on carpal tunnel syndrome

作　　者：李九一 徐树明 王建光[2] 朱新杰[2] 

机构地区：[1]南方医科大学附属第三临床医学院,广州市510515 [2]南方医科大学附属奉贤区中心医院疼痛科

出　　处：《临床麻醉学杂志》2017年第11期1082-1085,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察超声引导下正中神经阻滞治疗腕管综合征的临床效果。方法选择40例(69个患腕)腕管综合征患者,性别不限,年龄33~61岁,ASAⅠ或Ⅱ级。随机分为超声组(U组)和对照组(C组),每组20例。U组采用超声引导下正中神经阻滞,C组采用解剖标志定位正中神经阻滞,两组每次阻滞药物均为布比卡因4.5mg、曲安奈德5mg、维生素B12 100μg混合液3ml。通过Boston腕管问卷调查表(BCTQ)评估患者治疗前后手症状和功能;记录治疗前后正中神经电生理参数;记录二次治疗及不良反应情况。结果与治疗前比较,治疗后1个月两组BCTQ评分中的症状严重程度评分(SSS)和功能状态评分(FSS)明显降低(P<0.05),且U组SSS明显低于C组(P<0.05),两组FSS差异无统计学意义。与治疗前比较,治疗后1个月两组运动潜伏期(MDL)、感觉潜伏期(SDL3)明显缩短(P<0.05),感觉神经传导速度(SNCV)明显增快(P<0.05),而运动神经传导速度(MNCV)差异无统计学意义。治疗后1个月,U组SNCV明显快于C组(P<0.05),其余神经电生理参数两组差异无统计学意义。U组二次治疗及不良反应明显少于C组(P<0.05)。结论采用超声引导下神经阻滞治疗腕管综合征能显著改善患者的手部症状,减少并发症。Objective To observe the clinical effects of ultrasound-guided median nerve block on carpal tunnel syndrome.Methods A total of 40 patients（69 hands,aged 33-61 years,ASA Ⅰ orⅡ,were randomly assigned into ultrasound group（group U）and control group（group C）,20 cases in each.The ultrasound group underwent ultrasound-guided median nerve blocking,while the control group did through by anatomic landmark palpation.3 ml of 4.5 mg bupivacaine,5 mg triamcinolone acetonide and 100μg vitamin B12 was injected in a single shot in the two groups.Symptoms and functions were evaluated by Boston carpal tunnel questionnaire（BCTQ）at the onset and after the treatment.Electrophysiological parameters were recorded at the time of pretreatment and post-treatment.Cases receiving two or more and side effects were also recorded.Results Both the symptom severity scale（SSS）and funcational status scores（FSS） of the BCTQ showed significant decrease 1 month after treatment in the two group（P〈0.05）.Compared with group C,SSS of group U showed a significant decrease（P〈0.05）,while there was no significance difference in FSS.Compared with pretreatment,MDL,SDL3 showed a significant decrease and SNCV showed significant increase 1 month after treatment in the two group（P〈0.05）,while there was no significant change in the MNCV.SNCV was quicker in group U than in group C at 1 month after treatment（P〈0.05）,while other electrophysiological parameters were not significantly different between the two groups.Less cases with treatment times ≥2 and less side effects were found in group U than in group C（P〈0.05）.Conclusion Median nerve blocking under ultrasound guidance effectively improves the symptom in patients with carpal tunnel syndrome and reduces complications.

关 键 词：超声引导 正中神经阻滞 腕管综合征 

分 类 号：R614[医药卫生—麻醉学]