连续臂丛神经阻滞用于小儿上肢手术  

Continuous interscalene brachial plexus block for upper limb surgery in children

作　　者：王立文[1] 马秀光[1] 

机构地区：[1]解放军第五医院,宁夏银川750004

出　　处：《宁夏医学杂志》2002年第10期598-599,共2页Ningxia Medical Journal

摘　　要：目的　观察连续臂丛神经阻滞用于小儿上肢手术的可行性及临床效果。方法　 35例上肢手术患儿均采用经肌间沟入路臂丛神经阻滞 ,穿刺成功后 ,先注入 2 %利多卡因与 0 .5 %布比卡因复合液 0 .5 - 0 .6ml/kg(含1∶2 0万肾上腺素 ) ,注药后抽出针芯 ,随之将外套管向肌间沟内再送入 0 .2 - 0 .5cm并与三通相连接。术中视手术时间 ,经三通追加局麻药 ,平均用量为 14.3± 4.79ml。不合作者肌注氯胺酮 4- 6mg/kg后再行静脉和肌间沟穿刺。术中常规静脉滴入咪唑安定 0 .15 - 0 .3mg/kg维持麻醉 ,麻醉期间连续监测心电图 (ECG)、血压 (MAP)、心率(HR)、脉搏氧饱和度 (SpO2 )和呼吸频率 (RR)变化 ,手术历时 2 - 11小时。 12例病人术后留置套管 2 - 3天 ,用于注入低浓度局麻药或术后镇痛 (PCA)。结果　臂丛阻滞起效时间为 3- 5分钟 ,阻滞完善时间为 10 - 15分钟 ,麻醉效果均较满意 ,麻醉后呼吸和循环变化差异无显著性意义 (P >0 .0 5 )。发生霍纳氏综合征 7例 ,轻度局麻药中毒反应 1例 ,术后恢复顺利。结论　应用静脉套管针经肌间沟连续臂丛阻滞 ,取材方便、操作简单、效果可靠 ,术中管理容易 ,并发症少 。Objective To investigate the efficacy of continuous interscalene brachial plexus block for upper limb surgery in children.Methods Thirty-five patients, ASA physical status I and II, age ranged from 1.5-12 years and body weight 8-36kg.Scheduled for upper extremity major surgery,received continuous interscalene brachial plexus block ,The puncture using a 20 (1.1mm×48mm)G-22(0.9mm×25mm)G venous cannula needles,the both trocar and connecta plus 3 were linked and fixed by paste of 5cm×7cm.2% lidocaine and 0.5% bupivacaine mixture with epinephrine 1∶200,000 was used as local anesthetics,average doses of drugs was 14.3±4.8ml, if children not cooperation the ketamine 4-6mg/kg was intramuscular before into room,and the intravenous administration of midazolam 0.15-0.3mg/kg and ECG,MAP,HR,RR,SpO 2 were monitored during operation.Results Whole onset time of brachial plexus block was 3-5 min, all patients changes of respiratory and circulatory function the difference were no significantly(P>0.0 5) after anesthesia,Horner's syndrome 7case(20%) were noted, toxic reaction of local anesthetics occurred in 2.8% of the patients. Conclusions Indwelling catheter placement into the interscalene brachial plexus sheath as described in this communication was effective,it produced reliable anesthesia and associated with few complications and side effects.

关 键 词：儿童 上肢手术 臂丛神经阻滞 

分 类 号：R726.1[医药卫生—儿科] R726.582[医药卫生—临床医学]