神经刺激仪引导喙突旁入路双点注射臂丛神经阻滞的临床研究  

Effect of dual-injection on coracoid approach brachial plexus block guided by nerve stimulator:compared with single-injection

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 Qinhuangdao,Hebei Province,Qinhuangdao 066000,China;Department of Family Planning,Maternal and child Health Care Hospital of Qinhuangdao,Hebei Province,Qinhuangdao 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》2019年第2期193-197,共5页Journal of Hebei Medical University

摘　　要：目的观察喙突旁入路双点注射臂丛神经阻滞在上肢手术中的效果。方法选择美国麻醉医师协会Ⅰ～Ⅱ级拟行上肢肘关节及其远端部位手术的患者80例,随机分为双点注射组(D组)和单点注射组(S组),每组40例。采用神经刺激仪引导,实施喙突旁入路臂丛神经阻滞。S组诱发出目标肌肉运动后注射0.375%罗哌卡因40mL;D组需要诱发出2次不同的肌肉运动,每次注射0.375%罗哌卡因20mL。注射药物完毕后每隔5min测试臂丛在前臂终末神经的感觉和运动阻滞情况,并记录操作时间、成功率和并发症发生情况。结果 D组总体感觉和总体运动阻滞起效时间短于S组(P<0.05),D组尺神经和桡神经感觉阻滞起效时间短于S组(P<0.05),D组桡神经运动阻滞起效时间短于S组(P<0.05)。D组阻滞成功率高于S组(P<0.05)。D组操作时间长于S组(P<0.05)。2组均无明显并发症发生。结论双点注射能缩短喙突旁入路臂丛神经阻滞的感觉和运作阻滞起效时间,提高阻滞效果,不增加并发症发生率;但是需要更长的操作时间。Objective To observe the effect of Dual-injection on coracoid approach brachial plexus block guided by nerve stimulator for upper extremity surgery.Methods Eighty patients ASA classⅠ-Ⅱscheduled for surgery in elbow,forearm,wrist or hand were randomly divided into two group:Dual-injection group(group D)and singleinjection group(group S),40 patients in each group.All cases were received coracoid approach brachial plexus block guided by nerve stimulator.40 mL 0.375%ropivacaine was injected after evoking one target muscle movement in group S.While two different muscle movements need to be evoke in group D.Sensory block and motor block was evaluated every 5 minutes after injection of the local anesthetic.The time required to complete the block,success rate and complications were also tanked notes.Results The sensory block and motor block onset time in group D was significantly shorter than that in group S(P<0.05).The sensory block onset time for ulnar nerve and radial nerve in group D was significantly shorter than that in group S(P<0.05).The motor block onset time for radial nerve in group D were significantly shorter than that in group S(P<0.05).The success rate in group D was significantly higher than that in group S(P<0.05).The time required to complete the block in group D was longer than that in group S(P<0.05).No significant complications occurred in the two groups.Conclusion Dual-injection technique can shorten sensory block and motor block onset time and increase block effect without increasing the complications for coracoid approach brachial plexus block.But it requires longer time to complete the block.

关 键 词：神经传导阻滞 臂丛 喙突 双点注射 

分 类 号：R614[医药卫生—麻醉学]