连续锁骨下臂丛阻滞效果的影像学评价

Imaging Evaluation of the Effect of Continuous Brachial Plexus Blockade

目的:本研究的目的是通过X线影像学诊断来评价不同深度的锁骨下置管的成功率,以及对上肢手术术后镇痛效果的影响。材料和方法:本研究采用随机对照单盲的试验方法,在60例患者中,经锁骨下入路臂丛神经阻滞后导管留置的长度1cm为A组,3cm为B组。导管内注入对比剂,用C臂机摄片评价导管位置;同时术后6h、12h、18h、24h作VAS评分。结果:从影像学看,对比剂在锁骨下区域分布出现条索状和非条索状两种形态,导管留置1cm的条索状出现率高,其置管成功率大于留置3cm,有统计学意义。在术后镇痛方面,X线影像呈非条索状的患者镇痛前后VAS评分无明显下降,呈条索状的患者VAS评分大部分都下降。结论:连续锁骨下臂丛神经阻滞可以为手术患者提供完善的围麻期镇痛,导管的置入深度将会直接影响患者镇痛的效果,而X线影像则能很好地为麻醉医师提供客观的诊断标准,明显提高置管的成功率。

Purpose： We will discuss the efficacy of different length of catheter on upper limb surgery through the X - ray diagnosis. Meterials and Methods： Sixty adult patients scheduled for open rotator cuff repair were entered in this randomized, single - blinded study. Patients received an infraclavicular brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic, with the length of catheter of 1cm as Group A and 3cm as Group B, then assess the location of the catheter through the X - ray imaging after the contrast agent injected. 6h, 12h, 18h, 24h after infraclavicular block was measured. Results： X - ray showed two kinds of shape： strip and non - strip, when the length of catheter were lcm in Group A, the rate of strip is higher, the success rate was 93.3%, while the length of catheter was 3cm in Group B, the rate of strip is lower, and the success rate was 70%. The success rate of Group A was higher than Group B （P 〈 0.05） . In another hand, VAS scores of Group A is lower than Group B postoperation. Conclusion： Continuous infraclavicular brachial plexus block can provide excellent postoperative analgesia according to the X - ray imaging. The length of catheter left in infraclavicular approach should be 1cm, which can improve the success rate.