腋动脉上下入路行臂丛神经阻滞临床效果的比较

Comparation of Clinical Effect of Brachial Plexus Block between over the Axillary artery and below the Axillary Artery

目的比较足量罗哌卡因用于腋动脉上、下入路时对臂丛神经束的阻滞效果。方法选择50例需行前臂尺侧及手部尺侧手术的病人,随机分成,A1、B1两组,每组25例。A1组行腋动脉下入路臂丛神经阻滞,B1组行腋动脉上入路臂丛神经阻滞; 另选择50例需行前臂桡侧及手部桡侧手术的病人,分成A2、B2组,每组25例。A2组行腋动脉上入路臂丛神经阻滞,B2组行腋动脉下入路臂丛神经阻滞。各组局麻药均采用0．4％罗哌卡因,总量50ml。结果给药后15min,A1组阻滞效果优良率为100％, B1组阻滞效果优良率为84％,A2组阻滞效果优良率为100％,B2组阻滞效果优良率为96％;给药后20min,各组阻滞效果优良率均为100％。15min时,A组和B组之间阻滞效果有显著差别(P<0．01)。20min时,A组和B组之间阻滞效果并无显著差别 (P>0．05)。结论腋动脉下入路臂丛阻滞对尺侧外伤起效快,阻滞完全;腋动脉上入路对桡侧外伤起效快,阻滞完全。但在药物足够的情况下,随着时间的推移,药液逐渐扩散到邻近的筋膜腔,最终是可以达到阻滞完善的效果的。

Objective To compare the effect of enough dose of Ropivacaine on brachial plexus block between over the axillary artery and below the axillary artery. Methods The selected 50 patients who would be operated on the ulnar side of antebrachium or hand were randomly divided into two groups（A1 and B1） of 25 cases each. In A1 and B1 groups the brachial plexus blocks below the axillary artery over the axillary artery were performed respectively. The other selected 50 patients who would be operated on the radial side of antebrachium or hand were randomly divided into two groups（A2 and B2 ） of 25 cases each. In A2 and B2 group the brachial plexus blocks over the axillary artery and below the axillary artery were performed respectively. The total dose of 50ml of 0.4% Ropivacaine was used in each patient of all the group. Results After 15 minutes, the rates of excellent and favorable effects,were 100% in A1 group, 84 % in B1 group, 100% in A2 group,96% in B2 group. After 20 minutes,the rates of excellent and favorable effects were 100 % in all the groups. After 15 minutes, there was significant difference in the block effect between A and B（ P d0.01） . Conclusion The block over axillary artery approach is faster and better in patients with radial injury and the block bellow axillary artery approach is faster and better in the patients with ulnar injury,But if the dose is enough, as time goes on, the block effect of two approaches will be similar to each other.