逆行锁骨下臂丛神经阻滞的临床应用

Clinical application of retrograde infraclavicular approach for brachial plexus block

目的探讨逆行锁骨下臂丛神经阻滞(BPB)的效果。方法择期行上肢手术的患者90例随机分为三组,每组30例。在外周神经刺激器引导下行逆行锁骨下(A组)、肌间沟(B组)或锁骨上(C组)BPB穿刺,注入0.5%罗哌卡因40ml。记录感觉神经阻滞完善时间、不良反应。A组记录穿刺针进针深度,与矢状面、冠状面角度。结果A组感觉神经阻滞效果优于B、C组(P<0.05或P<0.01)。A组臂内侧皮、前臂内侧皮、正中、尺神经阻滞完善时间快于B组(P<0.01)。A组颈浅神经阻滞完善时间较B组慢(P<0.01)。A组不良反应与并发症明显少于B、C组(P<0.01)。结论逆行锁骨下BPB的感觉神经阻滞效果优于肌间沟法或锁骨上法。

Objective To evaluate the effectiveness retrograde infraclavicular approach for brachial plexus block（BPB）. Methods Ninety patients were randomized into three groups, with 30 eases each. Guided by a nerve stimulator, BPB was performed via retrograde infraclavicular approach in group A,interscalene approach in group B, or supraclavicular approach in group C. Sensory block, adverse effects and complications were recorded. Results The sensory block of group A was better than that of other two groups（P〈0.05）. The successful sensory block in the nerve distributions of the medial cutaneous of the arm, medial cutaneous of the forearm, median, ulnar in group A were quicker than those in group B （P〈0.05） and group C（P〈0. 01 ）. Appearrance of superficial cervical nerve block in group A was slower than that in group B （P〈0. 01）. Adverse effects and complications in group A were significantly less than those in groups B and C （P 〈 0.01 ）. Conclusion The effectiveness of BPB via retrograde infraclavieular approach is better than that via interscalene or supraclavieular approach.