颈5横突入路臂丛神经阻滞在肩部手术中的临床应用

Clinical application of brachial plexus block by C5 processus transversus approach undergoing shoulder surgery

目的:评价颈5横突入路肌间沟臂丛阻滞在肩部手术中的效果及安全性。方法:选择肩部手术60例,其中进行锁骨骨折手术32例,肩关节脱位手术8例,肱骨头及肱骨外髁颈骨折手术20例,随机分为两组,A组为对照组,为传统肌间沟阻滞;B组为改良肌间沟阻滞,经颈5横突水平入路。记录阻滞后30分钟各感觉神经阻滞情况,并评价阻滞效果,记录并发症情况。结果:B组优良率93.3%,A组优良率63.3%,B组较A组显著提高(P<0.05);B组对腋神经和C4神经阻滞效果较A组显著提高(P<0.05)。结论:经颈5横突入路的肌间沟臂丛阻滞,定位简单,较传统肌间沟法对肩部手术阻滞的优良率明显提高,是一种安全、可靠的臂丛阻滞方法。

Objective：To evaluate the value of brachial plexus block by C5 processus transversus approach undergoing shoulder surgery.Methods：60 ASAⅠor Ⅱ adult patients undergoing shoulder surgeries were randomly divided into two groups.In group A（n=30）, the patients received a routine method of intermuscular blocking anesthesia of brachialis plexus;In group B（ n=30）,the patients received a brachial plexus block by C5 processus transverses approach.0.25% ropivacaine injection was used as local anesthetic in two groups.The total of thir sensory distribution and the success rate of block were evaluated,then the complications were recorded.Results：The success rate in group B by C5 brachial plexus block was 93.3%,and significantly higher than that in group A （63.3%）（P〈0.05）.There was different sensory distribution between two groups.The success rate of axillary nerve and C4 block were higher in B group by C5 approach than in group A （P〈0.05）.Conclusion：Brachial plexus block by C5 processus transverses approach is simpler localization and greater success rate of block than routine myointergroove brachial plexus block for shoulder surgery.