一针法颈丛神经阻滞中颈浅丛阻滞的改良

Modification of superficial cervical plexus block anesthesia in clinic

目的探讨一针法颈丛神经阻滞中颈浅丛阻滞改良的临床应用的可行性和安全性。方法择期行甲状腺肿块手术的患者80例,随机分为两组,每组40例。实验组:采用改良颈浅丛神经阻滞法(即在胸锁乳突肌后缘中点皮下注射局部麻醉药阻滞颈浅丛)。对照组:采用C4横突一针阻滞法。局部麻醉药均为0.25%罗哌卡因。由麻醉医师和手术医师共同评价阻滞效果,监测抬头肌力,观察有无并发症发生等。记录患者麻醉前(T0)、麻醉后10 min(T1)、切皮时(T2)、分离瘤体时(T3)、手术结束时(T4)5个时间点的血压、心率(HR)、脉搏血氧饱和度(SpO2)。结果与同组T0时间点比较,对照组T2、T3时间点的收缩压(SBP)、舒张压(DBP)均显著升高(P值均<0.05),T1、T2、T3时间点的HR均显著增快(P值均<0.05);实验组T3时间点的SBP、DBP均显著升高(P值均<0.05),T2、T3时间点的HR显著增快(P值均<0.05)。实验组T2、T3时间点的SBP、DBP均显著低于对照组(P值均<0.05)。实验组的阻滞有效率为95%(38/40),显著高于对照组的80%(32/40,P<0.05)。两组各时间点的SpO2的差异均无统计学意义(P值均>0.05)。神经阻滞后,两组患者头颈活动均自如,无1例出现并发症。结论改良颈浅丛神经阻滞法是一种较好的麻醉方法,值得在临床推广应用。

Objective To investigate the clinical feasibility and safety of modified bilateral superficial cervical plexus nerve block anesthesia in clinic.Methods Eighty American Society of Anesthesiologists（ASA） Ⅰ or Ⅱ patients with thyroid mass were randomly allocated to experimental group and control group（n=40 each）.Experimental group was treated by modified bilateral superficial cervical plexus block,where the local anesthetic drug was directly injected in middle point of rear edge of sternocleidomastoid muscle by subcutaneous injection.Control group received cervical plexus block anesthesia in C4 transverse process（one-point method）.The two groups were all blocked with 0.25% ropivacaine.The efficacy,muscle strength of neck and complications of cervical plexus block were assessed by anesthetist and surgeon.The blood pressure（BP）,heart rate（HR）,and pulse oxygen saturation（SpO2） were monitored before block anesthesia（T0）,10 min after block anesthesia（T1）,incision of skin（T2）,operation（T3）,and after operation（T4）.Results Compared with T0 point,the systolic blood pressure（SBP） and diastolic blood pressure（DBP） were significantly increased at T2,T3 points in the control group（all P0.05）;HR was significantly increased at T1,T2,and T3 points in the control group（all P0.05）;SBP,DBP were significantly increased at T3 point and HR was significantly increased at T2,T3 points in the experimental group（all P0.05）.Compared with the control group,SBP and DBP were significantly lower in the experimental group at T2,T3 points.The anesthetic efficacy was 95%（38/40） in the experimental group,which was significantly higher than that in the control group（80%,P0.05）.There was no significant difference in SpO2 between the two groups（P0.05）.The head and neck of all patients could move freely and no patients showed serious complications after nerve block.Conclusion Bilateral superficial cervical plexus nerve block anesthesia under the skin of neck is a satisfactory;it has the advantages of being accurate,easy-to-perform,safe,effective,and cheap,with less complications;it is worth popularizing in clinic.