超声引导下肌间沟联合尺侧腋路阻滞在上肢手术中的应用  

Application of ultrasound-guided intermuscular groove combined with ulnar axillary block in upper limb surgery

作　　者：陈丽珍 王文武 李飞[2] 李晓莉 金磊 蔡忆 沈舒媛 CHEN Li-zhen;WANG Wen-wu;LI Fei(Department of Anesthesiology,The Fifth People's Hospital of Kunshan,Kunshan Jiangsu 215343,China;Department of Anesthesiology,The Fourth People's Hospital of Kunshan,Kunshan Jiangsu 215300,China)

机构地区：[1]昆山市第五人民医院麻醉科,江苏昆山215343 [2]昆山市第四人民医院麻醉科,江苏昆山215300

出　　处：《临床和实验医学杂志》2020年第17期1899-1903,共5页Journal of Clinical and Experimental Medicine

基　　金：江苏省卫生和计划生育委员会科研支撑项目(编号:ZKY201502)。

摘　　要：目的探讨超声引导下肌间沟联合尺侧腋路阻滞在上肢手术中的应用。方法回顾性分析2018年1月至2019年12月在昆山市第五人民医院麻醉科进行上肢手术的108例骨折患者的临床资料,按照麻醉方法将其分为两组:试验组和对照组,每组各54例。试验组患者采用超声引导下肌间沟联合尺侧腋路阻滞的麻醉方法,对照组患者采用盲探单纯肌间沟臂丛阻滞的麻醉方法。分析对比不同阻滞方式患者的神经分支阻滞完善时间、阻滞完善率、阻滞起效时间、术中麻醉优良率、术中神经阻滞使用率、麻醉持续时间、操作时间和麻醉相关不良反应发生情况。结果试验组患者的各神经分支的阻滞完善率明显高于对照组,差异具有统计学意义(P<0.05),试验组患者的各神经分支的阻滞完善时间和阻滞起效时间均明显少于对照组,差异具有统计学意义(P<0.05);试验组患者的术中麻醉优良率(98.15%)显著高于对照组(87.04%),差异具有统计学意义(P<0.05);试验组患者的术中芬太尼使用率(3.70%)显著低于对照组(24.07%),差异具有统计学意义(P<0.05);试验组患者的麻醉持续时间(369.87±46.12 min)、操作时间(9.78±0.98 min)明显长于对照组(307.99±34.10 min,4.32±0.80 min),差异均具有统计学意义(P<0.05);试验组患者的麻醉相关的不良反应发生率(5.56%)明显低于对照组(22.22%),差异具有统计学意义(P<0.05)。两组患者均未出现神经损伤、局麻药中毒等现象。结论上肢手术中应用超声引导下肌间沟联合尺侧腋路阻滞的临床效果显著,麻醉安全性较高。Objective To explore the application of ultrasound-guided intermuscular sulcus combined with ulnar axillary block in upper extremity surgery.Methods The clinical data of 108 patients with upper limb fracture who underwent upper limb surgery in the Department of Anesthesiology of the Fifth People’s Hospital of Kunshan from January 2018 to December 2019 were analyzed retrospectively.According to the random table method,they were divided into two groups:the experimental group and the control group,54 cases in each group.The patients in the experimental group were anesthetized by ultrasound-guided intermuscular sulcus combined with ulnar axillary block,while the patients in the control group were anesthetized by blind exploration of simple intermuscular sulcus brachial plexus block.To analyze and compare the perfect time,the perfect rate,the effective time,the excellent rate of intraoperative anesthesia,the use rate of intraoperative nerve block,the duration of anesthesia,the operation time and the adverse reactions related to anesthesia.Results The improvement rate of each nerve branch in the experimental group was higher than that in the control group (P<0.05).The control group (P<0.05).The excellent rate of anesthesia in the experimental group was 98.15%,significantly higher than that in the control group (87.04%).The difference was statistically significant (P<0.05).The use rate of fentanyl in the experimental group was 3.70%,significantly lower than the 14.81% and 24.07% of the control group,the difference was statistically significant (P<0.05);the anesthesia duration and operation time of the experimental group and the control group were statistically significant (P<0.05);the anesthesia related non use rate of the experimental group was statistically significant (P<0.05).The incidence of good reaction was 5.56%,which was lower than 22.22%of the control group (P<0.05).There was no nerve injury or local anesthetic poisoning in the two groups.Conclusion The clinical effect of ultrasound-guided intermuscular sulc

关 键 词：上肢手术 超声引导 肌间沟 尺侧腋路 臂丛神经阻滞 麻醉时间 

分 类 号：R614[医药卫生—麻醉学]