L型挡板加压对锁骨上臂丛神经阻滞效果及膈肌麻痹的影响  

Effect of L-shaped baffle compression on supraclavicular brachial plexus nerve block and diaphragmtic paralysis

作　　者：张亮光 庞如发 张龙 邱雯[1] 戚建武[2] ZHANG Liangguang;PANG Rufa;ZHANG Long;QIU Wen;QI Jianwu(Department of Anesthesiology,Ningbo NO.6 Hospital,Ningbo 315000,Zhejiang,China;Department of Hand Surgery,Ningbo NO.6 Hospital,Ningbo 315000,Zhejiang,China)

机构地区：[1]宁波市第六医院麻醉科,浙江宁波315000 [2]宁波市第六医院手外科,浙江宁波315000

出　　处：《中国现代医生》2023年第1期35-38,51,共5页China Modern Doctor

基　　金：宁波市鄞州区农业与社会发展领域科技项目(2019AS0026);宁波市医学科技计划项目(2020Y52)。

摘　　要：目的探究L型挡板加压对锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)效果及膈肌麻痹的影响。方法选取2021年3~10月于宁波市第六医院择期行右上肢手术的96例患者为研究对象,根据随机数字表法将其分为对照组和试验组,每组各48例。两组患者行SCBPB时均将L型挡板紧贴于超声探头头端,注药时试验组加压L型挡板,对照组未加压。比较两组患者的膈肌麻痹情况、感觉及运动阻滞起效和恢复时间、不良反应发生情况。结果阻滞30min后,试验组患者不同呼吸状态下膈肌的总麻痹率显著低于对照组(P<0.05),平静呼吸时膈肌完全麻痹发生率低于对照组(P<0.05),用力呼吸时膈肌部分麻痹发生率低于对照组(P<0.05)。试验组患者的感觉、运动阻滞起效时间均显著短于对照组,但感觉、运动恢复时间均显著长于对照组(P<0.05)。两组患者的麻醉相关并发症比较差异均无统计学意义(P>0.05),均未出现局部麻醉药中毒、神经损伤、气胸等严重并发症。结论L型挡板加压行SCBPB能降低膈肌麻痹的发生率,同时加快臂丛神经阻滞起效时间,延长阻滞恢复时间,未见明显不良反应。Objective To investigate the effects of L-shaped baffle compression and on supraclavicular brachial plexus block(SCBPB)and diaphragmatic paralysis.Methods A total of 96 patients who underwent elective operation on the right upper limb in Ningbo NO.6 Hospital from March to October 2021 were selected as research objects,and were divided into control group and experimental group according to random number table method,with 48 patients in each group.L-shaped baffle was placed close to the head of the ultrasound probe in both groups when SCBPB was performed.L-shaped baffle was pressurized in experimental group and not pressurized in control group.Diaphragmatic paralysis,onset and recovery time of sensory and motor block,and occurrence of adverse reactions were compared between the two groups.Results After blocking 30min,the total paralysis rate of diaphragm in experimental group was significantly lower than that in control group(P<0.05).The incidence of complete diaphragmatic paralysis in experimental group was lower than that in control group at rest(P<0.05),and the incidence of partial diaphragmatic paralysis in experimental group was lower than that in control group during forced breathing(P<0.05).The onset time of sensory and motor block in experimental group was faster than that in control group,but the recovery time of sensory and motor energy were significantly longer than those in control group(P<0.05).There was no significant difference in anesthesia-related complications between the two groups(P>0.05),and no serious complications such as local anesthetic poisoning,nerve injury and pneumothorax occurred.Conclusion SCBPB with L-baffle compression can reduce the incidence of diaphragmatic paralysis,accelerate the onset time of brachial plexus block,and prolong the recovery time of block.No obvious adverse reactions were observed.

关 键 词：锁骨上臂丛神经阻滞 罗哌卡因 膈肌麻痹 超声 

分 类 号：R614.4[医药卫生—麻醉学]