超声引导下臂丛神经阻滞在上肢手术中的应用

The clinical application of brachial plexus blockade by using ultrasound technique

目的观察超声引导下臂丛神经阻滞在上肢手术中的应用效果。方法40例急诊或择期行上肢或手部手术的患者，ASAⅠ～Ⅲ级，随机均分为超声引导组（US组）和传统解剖定位组（NS组），两组均合并使用神经刺激器，局麻药均为0．4％罗哌卡因，US组为30ml，NS组为40ml。观察两组麻醉操作完成时间、感觉阻滞起效时间、运动起效时间、感觉恢复时间、运动恢复时间。结果US组麻醉完成时间、感觉阻滞起效时间、运动阻滞起效时间明显短于NS组（P〈0．05或P〈0．01）。结论超声引导合并神经刺激器行臂丛神经阻滞可缩短麻醉完成时间，减少局麻药用药量，延长麻醉作用时间，减少并发症的发生。

Objective To obverse the clinical application of brachial plexus block by using an ultrasound technique. Methods Forty patients （ASA Ⅰ - Ⅲ ） undergoing upper extremity operations were randomly divided into 2 groups., group US（using real-time ultrasound image guiding and nerve stimulator） ; group NS（anatomic mark combined nerve stimulator）. 0. 4% ropivacaine were used by block in 30 ml （group US）,40ml （group NS） respectively. The time of anesthesia completed （To）, feeling-block starting （T1）, motion-block starting （T2）, feeling return （T3）, motion return （T4） were recorded. Local anesthetic diffusion pattern and complications after blockade were recorded. Results The time that anesthesia operation completed, the time feeling-block starting, motion-block starting in US group were obviausly shorter than group NS（P〈0. 05）. Conclusion Brachial plexus block by ultrasound-guiding combined nerve stimulator is a safe method with faster onset time, longer time of blockade, lower local anesthetic and less complication.