超声引导下两种锁骨下臂丛神经阻滞入路对膈肌麻痹的影响  

Effects of infraclavicular brachial plexus block with different approaches under ultrasound guidance on hemidiaphragmatic paralysis

作　　者：钱玉莹 黄娟娟[1] 丰浩荣[1] 安小凤[1] 王祥和[1] QIAN Yuying;HUANG Juanjuan;FENG Haorong;AN Xiaofeng;WANG Xianghe(Department of Anesthesiology, the PLA 98th Clinical College of Anhui Medical U- niversity, Huzhou 313000, China)

机构地区：[1]安徽医科大学附属解放军第九八临床学院麻醉科,浙江省湖州市313000

出　　处：《临床麻醉学杂志》2018年第6期562-565,共4页Journal of Clinical Anesthesiology

摘　　要：目的比较超声引导下肋锁间隙入路和喙突旁入路锁骨下臂丛神经阻滞对膈肌麻痹程度的影响。方法选择择期行右手或右前臂手术患者60例,男36例,女24例,年龄18~65岁,体重50~80kg,BMI 18~28kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:肋锁组(C组)和喙突组(P组),每组30例。C组行超声引导下肋锁间隙0.375%罗哌卡因30ml锁骨下臂丛神经阻滞;P组行超声引导下喙突旁0.375%罗哌卡因30ml锁骨下臂丛神经阻滞。记录操作时间、感觉和运动阻滞起效时间、感觉和运动功能恢复时间和不良反应包括Horner综合征、损伤血管、局麻药中毒、气胸、呼吸困难、神经损伤的发生情况。采用M型超声分别对平静呼吸和深呼吸状态下阻滞前、阻滞后30min的膈肌移动度进行测量并记录。结果 C组感觉和运动阻滞起效时间均明显短于P组(P<0.05)。两组操作时间、感觉和运动功能恢复时间差异无统计学意义。阻滞后30min深呼吸测量下C组膈肌部分麻痹率明显高于P组(43.3%vs 13.3%,P<0.05)。平静呼吸下C组与P组膈肌麻痹程度差异无统计学意义。两组无一例出现Horner’s综合征、损伤血管、局麻药中毒、气胸、神经损伤并发症。结论超声引导下肋锁间隙入路锁骨下臂丛神经阻滞较喙突旁入路起效时间短,但更易引起膈肌麻痹。Objective To compare the hemidiaphragmatic paralysis following ultrasoundguided costoclavicular verus paracoracoid infraclavicular block.Methods Sixty patients undergoing right hand or right forearm surgery,36 males and 24 females,aged 18-65 years,weighing 50-80 kg,BMI18-28 kg/m2,ASA physical statusⅠorⅡ,were randomized into 2 groups（n = 30 each）：costoclavicular approach group（group C）and paracoracoid approach group（group P）.Ultrasound-guided costoclavicular infraclavicular block of 30 ml of 0.375% ropivacaine was performed in group C,and ultrasound-guided paracoracoid infraclavicular block received with 30 ml of 0.375%ropivacaine was performed in group P.The block performance time,the onset time of sensory and motor block,recovery time of sensory and motor function,and adverse reactions including Horner＇s syndrome,injury of blood vessels,local anesthetic intoxation,pneumothorax,dyspnea,and neurologic injury were recorded.The hemidiaphragmatic movement was measured by M-mode ultrasonography under quiet and deep breathing test before the block procedure and at30 min after the block.Results Compared with group P,the onset time of sensory and motor block in group C were significantly shortened（P〈0.05）.The performance time and the recovery time of sensory and motor function had no significant difference between the two groups.There was a statistically significant difference in the degree of diaphragm paralysis between the two groups under deep breathing test 30 min after the block（P〈0.05）,the rate of partial hemidiaphragmatic paralysis in group C was higher than that in group P（43.3%vs 13.3%,P〈0.05）.The degree of diaphragm paralysis between the two groups under quiet breathing test 30 min after the block had no significant difference.There were no cases of Horner＇s syndrome,injury of blood vessels,local anesthetics,pneumothorax and nerve injury complications.Conclusion Ultrasound-guided costoclavicular infraclavicular brachial plexus block has a shorter onset time than paracorac

关 键 词：超声引导 锁骨下臂丛神经阻滞 膈肌 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]