改良锁骨下臂丛神经阻滞满意度的临床评价  

Clinical evaluation of the satisfaction of modified infraclavicular plexus block via a modified approach

作　　者：张强[1] 李朝阳[1] 彭莉萍[1] 吴冬[1] 叶庆明[1] 

机构地区：[1]深圳市南山区人民医院麻醉科,广东省深圳市518052

出　　处：《中国临床康复》2003年第20期2847-2848,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的介绍一种改良的锁骨下臂丛神经阻滞方法,通过临床应用评价其效果与并发症。方法选择86例ASAⅠ～Ⅲ级,行前臂、手和腕部择期手术患者进行前瞻性研究。56例患者采用周围神经刺激定位仪(StimuplexHNS11;B.BraunMelsungenAG,Melsungen)完成操作,其中20例置管。后30例患者采用找异感的方法,当患者有异感并放射到手的前臂或手指为针尖定位正确。结果总的阻滞成功率95%(82例)。使用神经刺激仪定位单次给药的感觉阻滞效果最好,其次是置管患者,而传统定位的效果相对较差。肌皮神经、前臂正中神经阻、腋神经与前臂内侧皮神经滞效果最好。穿刺针平均深度7.2cm(5.5～9.0cm)。有20例留置导管,均通过周围神经刺激定位仪成功完成,置管深度(9.0±3.5)cm,超过针尖深度3cm,手术麻醉效果均满意阻滞成功率100%。手指有手术后感觉异常51例,均在1周内完全消失。结论此方法操作简单,体表标志可靠,可置管后固定,有效避免气胸的发生。Aim To describe a modified approac h of in fraclavicular plexus block and to evaluate the clin ical characteristics o f this ap-proach.Methods The needle was inserted 3cm below the midpoint of t he midpoint of clavicle and anterrior a crominal process at a 40-60degree a n gle to the skin and directed laterally an d posteriorly toward the axillary ar tery within the axillary fossa,with the a rm abducted to 90degree and elevate d by approximately 30degree.The clinic al characteristics of this approach we re evaluated in 86patients scheduled f or elective surgery of the forearm,w r ist,or hand.Success was defined as a sensory block of the 7nerves within 30 min after performing the block.Results The success rate was 97%when a dista l response was elicited using a nerve stimulator,and 95%when no using a nerv e stimulator.Complications were rare:aspiration of blood was seen in3%of pat ients;no pneumothorax occu rred.12patients complained of some pain during t he procedure.The degre e of patient satisfaction was 100%.Conclusion The n ew approach is very effective wi th a small complication rate and a high degree of patient satisfaction.

关 键 词：锁骨 臂丛神经阻滞 满意度 并发症 麻醉 

分 类 号：R614.4[医药卫生—麻醉学]