上肢手术病人超声引导锁骨上臂丛神经阻滞的效果

Ultrasound-guided supraclavicular brachial plexus block for upper extremity operation

目的探讨上肢手术病人超声引导锁骨上臂丛神经阻滞的效果。方法拟在锁骨上臂丛神经阻滞下行上肢手术病人120例,ASA Ⅰ-Ⅲ级,随机分为3组(n=40):超声引导组(U组)、神经刺激器组(N组)、传统方法组(T组)。局麻药为0．75％罗哌卡因与2％利多卡因等容量混合液,剂量为0．4ml·kg-1。记录肌皮神经、桡神经、正中神经、尺神经阻滞的起效时间,并评价其阻滞完善率; 评定手术全程的麻醉效果(优、良、差),记录并发症。结果 U组4根神经阻滞完善率均接近100％ (P>0．05),N组和T组尺神经的阻滞完善率均低于肌皮神经和桡神经(P<0．05)。与T组比较,U 组和N组正中神经阻滞完善率均较高,麻醉优良率较高,起效时间均较短(P<0．05或0．01)。与N组比较,U组尺神经阻滞完善率和麻醉优等率较高,起效时间较短(P<0．01)。T组穿刺过程中有3例误入血管,3组均无严重并发症。结论上肢手术病人超声引导锁骨上臂丛神经阻滞较神经刺激器辅助和传统方法下的阻滞效果更好,起效时间更短,在临床上具有推广应用价值。

Objective To compare the effectiveness of supraclavicular brachial plexus block guided by ultrasound with that guided by nerve stimulator or anatomical landmarks. Methods One hundred and twenty ASA Ⅰ -Ⅲ patients （81 male, 39 female） aged 16-62 yrs weighing 40-75 kg scheduled for upper extremity operation under brachial plexus block via supraclavicular approach were randomized into 3 groups （ n =40 each） ： In group U block was guided by ultrasound; in group N nerve stimulator was used to locate the brachial plexus and in group T block was performed in the traditional way based on anatomical landmarks. A mixture of equal volumes of 0.75% ropivacaine and 2% lidocaine （0.4 ml·kg^-1）was injected in the 3 groups. The onset and intensity of sensory block of musculocutaneous, median, radial and ulnar nerves were measured and analgesia was rated as excellent, effective and failure. Results The rate of satisfactory block of ulnar nerve was significantly lower than that of musculocutaneous and radial nerves in group N and T （ P 〈 0.05 ） . While in group U there was no significant difference in the intensity of block of the three nerves and the block of ulnar nerve was satisfactory. The rate of satisfactory median nerve block was significantly higher in group U and N than in group T. The onset time of the block of the 4 nerves was longest in group T and shortest in group U （ P 〈0.01 ）. The effective rate was 100 % in group U, 92.5% in group N and 47.5% in group T （P 〈 0.05）. Excellent block （surgery was accomplished without supplementary drugs） was achieved in 95.5% of the patients in group U; in 70% in group N and 47.5% in group T. Inadvertent arterial puncture occurred in 3 patients. There was no major complication produced by the block in all the 3 groups. Conclusion Ultrasound-guided supraclavicular brachial plexus block for operations on upper extremity is significantly better than the other two techniques in terms of onset time and success rate of the block.