超声引导下改良肋锁间隙臂丛神经阻滞用于前臂手术的效果  

Efficacy of ultrasound-guided modified brachial plexus block at costoclavicular space for forearm surgery

作　　者：李品菲 郭璇 洪四名[1] Li Pinfei;Guo Xuan;Hong Siming(Department of Anesthesiology,Tongcheng People′s Hospital,Tongcheng 231400,Anhui Province,China)

机构地区：[1]安徽省桐城市人民医院麻醉科,桐城231400

出　　处：《中华麻醉学杂志》2022年第2期203-206,共4页Chinese Journal of Anesthesiology

摘　　要：目的:评价超声引导下改良肋锁间隙(CCS)臂丛神经阻滞用于前臂手术的效果。方法:2020年9月至2021年5月择期行前臂手术患者80例,性别不限,年龄18~75岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=40):一点注射对照组(C组)和两点注射改良组(T组)。均在超声引导下实施CCS臂丛神经阻滞,C组在CCS前室进行一点注射,T组在CCS前、后室进行两点注射,2组注射药物均为1.0%利多卡因和0.375%罗哌卡因混合液20 ml。记录注射局麻药后5、10、15、20、25和30 min各支神经的阻滞效果、阻滞起效时间、阻滞完善时间、阻滞持续时间以及麻醉相关不良反应的发生情况。结果:与C组比较,T组注射局麻药后5~20 min时桡神经运动阻滞率、10和15 min时肌皮神经和桡神经感觉阻滞率、15~30 min时正中神经运动阻滞率和20~30 min时尺神经感觉及运动阻滞率升高,阻滞起效时间和阻滞完善时间缩短(P<0.05)。2组阻滞持续时间及麻醉相关不良反应发生率比较差异无统计学意义(P>0.05)。结论:超声引导下改良CCS臂丛神经阻滞用于前臂手术的效果较好。Objective To evaluate the efficacy of ultrasound-guided modified brachial plexus block at costoclavicular space(CCS)for forearm surgery.Methods Eighty patients of both sexes,aged 18-75 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective forearm surgery from September 2020 to May 2021 in our hospital,were randomized into 2 groups(n=40 each)using a random number table method:single-injection control group(group C)and double-injection modified group(group T).Single-injection was performed in the anterior chamber of CCS in group C,double-injection was performed in the anterior and posterior chambers of CCS in group T,and the solution injected in both groups was a mixture(20 ml)of 1.0%lidocaine and 0.375%ropivacaine.The effect of block,onset time of block,completion time of block and duration of block for each nerve branch and anesthesia-related adverse reactions were recorded at 5,10,15,20,25 and 30 min after injection of local anesthesia.Results Compared with group C,the rate of motor block of radial nerve at 5-20 min after injection of local anesthesia,the rate of sensory block of musculocutaneous nerve and radial nerve at 10 and 15 min after injection of local anesthesia,the rate of motor block of median nerve at 15-30 min after injection of local anesthesia and the rate of sensory and motor block of ulnar nerve at 20-30 min after injection of local anesthesia were significantly increased,and the onset time and completion time of block were shortened in group T(P<0.05).There was no significant difference between the two groups in the duration of block and anesthesia-related adverse reactions(P>0.05).Conclusions Ultrasound-guided modified brachial plexus block at CCS provides better efficacy for forearm surgery.

关 键 词：超声检查 臂丛神经 神经传导阻滞 前臂 肋锁 

分 类 号：R614[医药卫生—麻醉学]