成人肌间沟臂丛神经阻滞运动反应终点的研究

A study on endpoint of motor response in interscalene brachial plexus block in adults

目的研究胸大肌、三角肌运动反应作为外周神经刺激器(PNS)定位下成人经肌间沟臂丛神经阻滞终点的可行性。方法择期成人上肢手术240例,PNS定位下行经肌间沟臂丛神经阻滞,随机均分为四组:胸大肌运动反应终点组(A组)、三角肌运动反应终点组(B组)、肱二头肌运动反应终点组(C组)和胸大肌、三角肌或肱二头肌运动反应终点组(D组)。比较组间刺激域电流、获得终点时间、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果。结果D组获得终点时间短于A、B、C组(P<0.05),组间刺激域电流、运动阻滞起效时间、各神经分支感觉阻滞起效时间、运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果差异无统计学意义。神经阻滞综合优良率90.8%。结论胸大肌、三角肌运动反应终点可作为PNS定位下成人经肌间沟臂丛神经阻滞穿刺针正确定位的满意、安全标志。

Objective To study the feasibility of pectoralis major, deltoid motor response as the endpoint in interscalene brachial plexus bloek（ISBPB） guided by peripheral nerve stimulator（PNS） in adults. Methods Two hundred and forty adult patients scheduled for upper limbs surgery under ISBPB guided by PNS were randomly divided into 4 groups of endpoint of pectoralis major motor response（A）, of deltoid motor response （B）, of biceps motor response （C） and of pectoralis major, deltoid or biceps motor response（D） with 25 cases each. Threshold current of stimulation, time to acquiremenl of endpoint, time to onset of motor block, time to onset of sensory block of nerve branches, effect of motor block, effect of sensory block of nerve branches and comprehensive effect of nerve block were compared among the four groups. Results The time to acquirement of endpoint of group D was less than that of group A,B and C （P〈0.05） ,threshold current of stimulation, time to onset of motor block, time to onset of sensory block of nerve branches, effect of motor block, effect of sensory block of nerve branches and comprehensive effect of nerve block had no statistical difference among the four groups. The excellent and good rate of nerve block was 90. 8%. Conclusion Endpoint of pectoralis major, deltoid motor response were satisfactory and safe indication for an accurate needle placement during interscalene braehial plexus block guided by PNS in adults.