持续臂丛神经阻滞用于小儿较长时间上肢手术

Application of continuous brachial plexus block in prolonged upper limb operation on children

目的 :探讨小儿持续臂丛阻滞麻醉方法及可行性。方法 :本组 4 2例采用硫喷妥钠、r -羟丁酸钠作为基础麻醉 ,肌间沟臂丛神经穿刺置放留置针管 (2 4号 3.0cm的留置针 ) ,据年龄采用不同浓度的利多卡因。分别于基础麻醉入睡时 ,入睡后5min、臂丛穿刺时、切皮时、1h、2h、缝皮时的直接桡动脉测压 ,包括收缩压 (SBP)、舒张压 (DBP)、脉搏 (P)、呼吸 (R)及血氧饱和度 (SPO2 )。观察有无气胸、全脊麻、局麻药毒性反应、霍纳综合征、血管损伤和膈神经阻滞等并发症。结果 :本组病例麻醉镇痛完善 ,切皮时、手术 1h、2h、缝皮时与基础麻醉入睡 5min时比较循环和呼吸功能变化不大 ,差异无显著性 (P >0 .0 5 )。其中回抽有血 2例 ,经压迫重新穿刺置管成功 ,麻醉完善 ;霍纳综合征 3例 ;无局麻药毒性反应、气胸等并发症。结论 :上肢手术采用留置针持续臂丛神经阻滞是简便可行的、安全、并发症少 。

Objective:To explore the methods and feasibility of continuous brachial plexus block in pediatric upper limb operation.Methods:After undergoning basal anesthesia with sodium pentothal and gamma hydroxy sodium butylate,42 children scheduled for upper limb operation were punctured and inserted with catheter from brachial plexus.Lidocaine was injected in different doses according to the age.Invasive blood pressure of radial artery,pulse,respiration rate and SPO 2 were observed at different time points.Results:There was no obvious difference in respiration and circulation at different time points( P >0.05).42 children were anesthetized perfectly except 3 cases with Horner syndrome and 2 failure cases.The complication such as hematoma and infection did not happen.Conclusion:Continuous brachial plexus block is a simple,feasible and safe method in complex and prolonged operation of upper limb.