超声引导在小儿上肢手术腋路臂丛神经阻滞麻醉中的应用  

Application of ultrasonic guidance in brachial plexus block anesthesia for pediatric upper extremity operation

作　　者：梁延伟 李帅晓 LIANG Yanwei;LI Shuaixiao(The 989 Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China,Pingdingshan,Henan Province 467000)

机构地区：[1]中国人民解放军联勤保障部队第九八九医院,河南平顶山467000

出　　处：《北京生物医学工程》2024年第3期291-295,共5页Beijing Biomedical Engineering

摘　　要：目的非插管浅全身麻醉复合腋路臂丛神经阻滞麻醉方法可以避免传统气管插管全麻带来的气管插管/拔管过程中的机械损伤,以及较大剂量镇静、镇痛药剂导致的患者用药危险及术后恢复时间的延长。但由于小儿臂丛神经解剖结构的特殊性,臂丛神经的定位方法难度较大,为此临床尝试采用超声引导技术解决术中穿刺定位不准确难题,本文旨在探讨超声引导在非插管浅全麻复合腋路臂丛阻滞下小儿上肢手术麻醉中的应用效果。方法选取2018~2023年间联勤保障部队第九八九医院开展完成的采用腋路臂丛阻滞麻醉的小儿上肢手术患者,按照是否采用超声引导进行臂丛阻滞情况分为实验组和对照组。通过对比分析两组手术患者在臂丛神经阻滞时间、麻醉药剂用量、麻醉药物起效时间、苏醒后各时间点手术后疼痛评估FLACC评分,以及术后不良反应等指标的异同,探讨超声引导在小儿上肢手术腋路臂丛神经阻滞麻醉中的应用效果。结果共有190例患者入组,其中实验组55例,对照组135例,两组患者在性别、年龄、身高、体重和疾病类型等临床资料上差异无统计学意义(P>0.05),具有可比性;研究组的局麻药物罗哌卡因用量明显少于对照组(P<0.01),但神经阻滞起效时间却明显快于对照组(P<0.01);整个手术期间研究组的麻醉药物丙泊酚和芬太尼用量,以及术后苏醒时间均少于对照组(P<0.05);且对照组有8例患者发生分支阻滞补救,8例患儿术后使用布洛芬止痛,2例出现恶心呕吐,1例患儿发生苏醒期躁动,明显高于研究组的发生率(P<0.01)。结论超声引导在小儿上肢手术腋路臂丛神经阻滞麻醉中具有重要作用。Objective Compared with conventional tracheal intubation general anesthesia,non-intubating shallow general anesthesia combined with axillary brachial plexus block anesthesia can avoid mechanical injury during tracheal intubation/extubation,as well as medication risk caused by large doses of sedative and analgesic drugs and prolongation of postoperative recovery time.However,due to the special anatomical structure of brachial plexus in children,it is difficult to locate brachial plexus.Therefore,ultrasound guidance technology is clinically attempted to solve the problem of inaccurate puncture positioning during surgery.This paper aims to explore the application effect of ultrasound guidance in pediatric upper limb surgery anesthesia under non-intubating shallow general anesthesia combined with axillary brachial plexus block.Methods Pediatric patients who underwent upper limb surgery and used axillary brachial plexus block anesthesia in Pingdingshan Hospital of Henan Province from 2018 to 2023 were selected and divided into study group and control group according to whether or not they underwent brachial plexus block with ultrasound guidance.By comparing the differences of parameters,such as brachial plexus block time,anesthetic drug dose,anesthetic drug onset time,postoperative pain evaluation FLACC score at each time point after recovery,and postoperative adverse reactions,the application effect of ultrasound guidance in axillary brachial plexus block anesthesia for upper limb surgery in children was evaluated.Results A total of 190 patients were enrolled,55 cases were in the study group and 135 in the control group.There was no statistical significance in clinical data such as gender,age,height,weight and disease type between the two groups(P>0.05).The dosage of ropivacaine in the study group was significantly lower than that in the control group(P<0.01),but the onset time of brachial plexus block was significantly earlier than that in the control group(P<0.01).The amount of anesthetic drugs propofol and fentany

关 键 词：超声设备 超声引导 臂丛神经阻滞 非插管全身麻醉 小儿上肢手术 应用效果 

分 类 号：R318.6[医药卫生—生物医学工程]