不同方法引导连续臂丛神经阻滞的效果：有效性、安全性及舒适性的比较  

Efficacy of continuous brachial plexus block guided by different methods： comparison of effectiveness, safety and comfort

作　　者：张进[1] 吴文知[1] 周颖 张兰[1] Zhang Jin, Wu Wenzhi, Zhou Ying, Zhang Lan(Department of Anesthesiology, Sichuan Orthopedic Hospital, Chengdu 610041, China)

机构地区：[1]四川省骨科医院麻醉科,成都市610041

出　　处：《中华麻醉学杂志》2018年第4期443-446,共4页Chinese Journal of Anesthesiology

摘　　要：目的 比较不同方法引导连续臂丛神经阻滞的有效性、安全性及舒适性.方法 择期全麻下行肘关节骨折内固定术病人189例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重46～90 kg,性别不限.采用随机数字表法分为3组（n=63）：超声联合神经刺激仪引导连续腋入路臂丛神经阻滞组（A组）、超声联合神经刺激仪引导连续喙突旁入路臂丛神经阻滞组（B组）和超声引导连续喙突旁入路臂丛神经阻滞组（C组）.3组分别注射0.2％罗哌卡因30 ml行臂丛神经阻滞,采用针刺法测定阻滞效果满意后,静脉注射舒芬太尼0.3 μg/kg、丙泊酚2～3 mg/kg和罗库溴铵0.6 mg/kg行麻醉诱导.吸入1.5％～2.5％七氟醚,静脉输注丙泊酚2～4 mg·kg^-1·h^-1行麻醉维持.术毕拔除气管导管后,行病人自控神经阻滞镇痛,药物配方：0.2％罗哌卡因,用生理盐水稀释至200 ml.参数设置：背景输注速率5 ml/h,PCA剂量5 ml,锁定时间60 min.3组均镇痛至术后72 h,维持VAS评分≤3分.当VAS评分＞3分时,肌肉注射曲马多100 mg补救镇痛.记录舒适度评分和术后72 h内补救镇痛情况;记录穿刺操作过程中气胸、局麻药中毒和血管内穿刺以及术后导管脱落、恶心呕吐和神经损伤不良反应发生情况.结果 与A组比较,B组和C组舒适度评分升高,补救镇痛率降低（P＜0.05）;与B组比较,C组舒适度评分升高（P＜0.05）,补救镇痛率差异无统计学意义（P＞0.05）.3组间不良反应发生率比较差异无统计学意义（P＞0.05）.结论 喙突旁入路连续臂丛神经阻滞的有效性和舒适性优于腋入路连续臂丛神经阻滞,单纯超声引导喙突旁入路连续臂丛神经阻滞的舒适性优于超声联合神经刺激仪引导.Objective To compare the effectiveness,safety and comfort of continuous brachial plexus block （BPB） guided by different methods.Methods A total of 189 patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,weighing 46-90 kg,undergoing elective internal fixation after elbow fracture under general anesthesia,were divided into 3 groups （n =63 each） using a random number table：ultrasound combined with nerve stimulator-guided axillary approach to continuous BPB group （group A）,ultrasound combined with nerve stimulator-guided subclavian coracoid approach to continuous BPB group （group B） and ultrasound-guided subclavian coracoid approach to continuous BPB group （group C）.Brachial plexus nerve block was performed with 0.2% ropivacaine 30 ml,and anesthesia was induced by Ⅳ injection of sufentanil 0.3 μg/kg,propofol 2-3 mg/kg and rocuronium 0.6 mg/kg after confirmation of satisfactory block using the acupuncture method in the three groups.Anesthesia was maintained by inhalation of 1.5%-2.5% sevoflurane and Ⅳ infusion of propofol 2-4 mg · kg^-1 · h-1.Patient-controlled nerve block analgesia was performed after removal of endotracheal tube at the end of surgery.Analgesia solution contained 0.2% ropivacaine which was diluted to 200 ml in normal saline.Parameter settings were adjusted with background infusion at rate 5 ml/h,5 ml bolus dose and 60 min lockout interval.Analgesia lasted until 72 h after surgery,maintaining a visual analog scale score less than or equal to 3.When the visual analog scale score was more than 3,tramadol 100 mg was intramuscularly injected as a rescue analgesic.Comfort scores,requirement for rescue analgesic within 72 h after surgery,development of pneumothorax,local anesthetic intoxication and intravascular puncture during puncture operation and development of postoperative adverse reactions such as tube shedding,nausea and vomiting and nerve damage were recorded.Results Compared with group A,the comfort score was signifi

关 键 词：臂丛 神经传导阻滞 

分 类 号：R614[医药卫生—麻醉学]