可视化臂丛神经阻滞的研究

Brachial plexus block under real-time ultrasonic monitoring

目的：探讨超声引导下臂丛神经定位的准确性,提高超声实时监测下臂丛神经阻滞的成功率、减少并发症。方法：采用彩色多普勒超声诊断仪,对31例患者行超声实时监测下臂丛神经阻滞。确定穿刺针位于神经束后注入1%利多卡因和0.25%布比卡因合剂515 ml。结果：臂丛神经声像图横切面表现为圆形或椭圆型低回声结构,边界清楚,排列整齐,纵断面可追溯至椎管,起始处略粗,平均直径约（2.0±0.7）mm,神经阻滞成功率为100%（31/31）;未发生并发症及不良反应。结论：超声实时监测下臂丛神经阻滞的方法能清晰显示臂丛神经的形态及周围组织关系,观察到局麻药注射后的扩散规律,为臂丛神经阻滞提供了影像学支持,从而提高了神经定位的准确性。

Objective：To investigate the precise positioning of brachial plexus under the guidance of ultrasound,to increase the achievement ratio of nerve block and reduce the complications.Methods：A total of 31 patients underwent brachial plexus block under the real-time ultrasonic monitoring.The mixture of 1% lignocaine and 0.25% bupivacaine（5 to 15 ml） was injected after the puncture needle was located in the nerve bundle.Results：The transverse section of brachial plexus was circular or elliptic structure of low-echoing,with clear border and regular alignment.The vertical section was a little thicker at the starting point,and could be ascended to the spinal canal.The mean diameter was（2.0±0.7） mm.The achievement ratio of nerve block was 100%（31/31） and no complication or adverse reaction took place.Conclusion：Real-time ultrasonic monitoring clearly show the structure of brachial plexus and surrounding tissue,and make it easy to observe the diffuse pattern of the injected local anaesthetics.These advantages of real-time ultrasonic monitoring provide imaging support for the precise positioning of brachial plexus block.