肌间沟联合改良锁骨上两点臂丛阻滞的临床观察

Clinical Effect of Tow-point Brachial Plexus Block by Combination of Interscalene and Supraclavicular Approach

目的比较肌间沟、改良锁骨上和肌间沟联合改良锁骨上3种臂丛阻滞法在上臂、前臂、手部手术中的麻醉效果。方法 90例上臂、前臂、手部手术患者按随机数字表分为A、B、C 3组,每组30例。A组于肌间沟C6横突水平与皮肤垂直进针,出现异感或触及横突时注入1.0%利多卡因+0.5%罗哌卡因混合液20 mL;B组于胸锁乳突肌锁骨头外侧缘与锁骨交界处,进针点垂直于手术台刺入,找异感时,针尖可向外向上移动,找到异感后注入上述麻药20 mL;C组同A、B组方法分别注入上述麻药各10 mL。根据患者主诉和主刀医师评定阻滞效果。结果 A组中Ⅰ级的百分率高于B组(P<0.05),而Ⅲ级的百分率低于B组(P<0.05);C组中Ⅰ级的百分率高于A、B组(P<0.01),而Ⅲ级的百分率低于A、B组(P<0.01)。3组不良反应的发生率比较差异无统计学意义(P>0.05)。结论对于上臂、前臂、手部手术,肌间沟联合改良锁骨上两点臂丛阻滞的效果明显优于各自的单点阻滞法。

Objective To compare the anesthetic effects of three brachial plexus blocks in surgery of the upper arm,forearm and hand,including interscalene approach,supraclavicular approach and the combination of the tow points anesthesia.Methods Ninety patients requiring brachial plexus block for upper arm,forearm and hand operation were randomly divided into A,B and C groups,with 30 cases in each group.In group A,the needle was inserted perpendicularly to the skin at C6 transverse process with the injection of 20 mL mixture of 1.0% lidocaine and 0.5% ropivacaine.In group B,the needle was inserted perpendicularly to the operating table with the injection of the same 20 mL mixture at the juncture of clavicle and the lateral side of clavicular part of sternocleidomastoid muscle.In group C,10 mL mixture was injected into the above tow points with the same methods as in group A and B,respectively,according to patient＇s chief complaint and orthopedist＇s judgement.Results The percentage of grade Ⅰ in group A was significantly higher than that in group B（P〈0.05）,while the percentage of grade Ⅲ in group A was significantly lower than that in group B（P〈0.05）.The percentage of grade Ⅰ in group C was significantly higher than that in group A and B（P〈0.01）,while the percentage of grade Ⅲ in group C is significantly lower than that in group A and B（P〈0.01）.There was no significant difference in the incidence of adverse reaction among the three groups（P〉0.05）.Conclusion For upper arm,forearm and hand operation,the anesthetic effect of tow-point brachial plexus is better than that of single point brachial plexus block.