尺动脉血流动力学参数在肋锁间隙臂丛神经阻滞效果评价中的意义  

Significance of ulnar artery hemodynamic parameters in evaluating the effect of costo-clavicular space brachial plexus block

作　　者：李旭 侯玉书 魏勇 崔晓媛 金梅生 沈千贺 LI Xu;HOU Yushu;WEI Yong;CUI Xiaoyuan;JIN Meisheng;SHEN Qianhe(Anesthesiology Department,Xi'an Hospital of Traditional Chinese Medicine,Xi'an 710021;Ultrasound Department,Xi'an Hospital of Traditional Chinese Medicine,Xi'an 710021;Anesthesiology Department,Gem Flower Xi'an Changqing Staff Hospital,Xi'an 710200,China)

机构地区：[1]西安市中医医院麻醉科,陕西西安710021 [2]西安市中医医院超声科,陕西西安710021 [3]西安宝石花长庆医院麻醉科,陕西西安710200

出　　处：《临床医学研究与实践》2023年第11期76-79,共4页Clinical Research and Practice

摘　　要：目的探讨尺动脉血流动力学参数在肋锁间隙臂丛神经阻滞效果评价中的意义。方法选择2019年6月至2020年3月西安市中医医院尺骨、尺侧指骨或掌骨骨折患者,共50例,剔除5例术中探查发现尺动脉损伤的患者,共45例患者纳入本研究,行肋锁间隙臂丛神经阻滞。于阻滞前(T_(0))、阻滞后5 min(T_(1))、阻滞后10 min(T_(2))、阻滞后15 min(T_(3))、阻滞后20 min(T_(4))、阻滞25 min(T_(5))和阻滞后30 min(T_(6))测定尺动脉血流动力学参数,记录针刺痛触觉评分,将T_(6)时针刺痛触觉评分为2分的纳入A组(28例),<2分的纳入B组(17例)。记录不同时间点的尺动脉多普勒频谱;比较患者不同时间点的尺动脉血流动力学参数及针刺痛触觉评分;比较A组、B组患者不同时间点的尺动脉血流动力学参数。结果所有患者T_(1)~T_(6)时舒张早期负向波消失。与T_(0)时相比,T_(1)~T_(6)时尺动脉横截面积(CSA)、前后径(APD)增大,收缩期峰值流速(PSV)、舒张末期流速(EDV)、时间平均流速(TAV)增快,血流量(BF)增多,阻力指数(RI)降低,针刺痛触觉评分升高(P<0.01)。与T_(0)时比较,T_(6)时两组的APD增大,EDV、TAV增快,BF增多,RI降低(P<0.05);A组T_(0)与T_(1)时的CSA、APD、PSV、EDV、TAV、BF、RI比较,差异具有统计学意义(P<0.05);B组T_(0)与T_(1)时的CSA、APD、PSV、EDV、TAV、BF比较,差异无统计学意义(P>0.05)。结论肋锁间隙臂丛神经阻滞时,尺动脉血流频谱的形态改变及阻滞后30 min APD、EDV、TAV、BF、RI变化可用于评价尺神经支配区域的痛觉阻滞效果;阻滞后5 min CSA、APD、PSV、EDV、TAV、BF变化可用于评价尺神经支配区域触觉阻滞效果。Objective To investigate the significance of ulnar artery hemodynamic parameters in evaluating the effect of costo-clavicular space brachial plexus block.Methods From June 2019 to March 2020,a total of 50 patients with ulnar,ulnar phalangeal or metacarpal fractures were selected from Xi'an Hospital of Traditional Chinese Medicine.Five patients with ulnar artery injury found during intraoperative exploration were excluded.A total of 45 patients were included in this study and underwent costo-clavicular space brachial plexus block.The ulnar artery hemodynamic parameters were measured at before block(T_(0)),5 min(T_(1)),10 min(T_(2)),15 min(T_(3)),20 min(T_(4)),25 min(T_(5))and 30 min(T_(6))after block,and acupuncture pain tactile score was recorded.At T_(6),the patients with acupuncture pain tactile score of 2 were included in group A(28 cases),and<2 were included in group B(17 cases).The Doppler spectrum of ulnar artery at different time points were record;the ulnar artery hemodynamic parameters and acupuncture pain tactile score at different time points were compared;the ulnar artery hemodynamic parameters of the group A and the group B at different time points were compared.Results All patients early diastolic negative waves disappeared at T_(1) to T_(6).Compared with T_(0),at T_(1) to T_(6),the cross-section area(CSA)and anteroposterior diameter(APD)of ulnar artery enlarged,the peak systolic velocity(PSV),end-diastolic velocity(EDV)and time averaged velocity(TAV)accelerated,blood flow(BF)increased,resistance index(RI)decreased,and acupuncture pain tactile score increased(P<0.01).Compared with T_(0),at T_(6),the APD of the two groups enlarged,EDV and TAV accelerated,BF increased,and RI decreased(P<0.05);there were statistically significant differences in CSA,APD,PSV,EDV,TAV,BF and RI between T_(0) and T_(1) in the group A(P<0.05);there were no statistically significant differences in CSA,APD,PSV,EDV,TAV and BF between T_(0) and T_(1) in the group B(P>0.05).Conclusion When costo-clavicular space brachial plexus b

关 键 词：肋锁间隙 臂丛神经阻滞 尺动脉 血流动力学参数 

分 类 号：R614[医药卫生—麻醉学]