神经刺激器用于小儿臂丛阻滞复合丙泊酚全麻的研究

Application of brachial plexus block using the peripheral nerve stimulator combined with a small dose of propofol for upper extremity surgery in pediatric anesthesia

目的 通过周围神经刺激器（peripheral nerve stimulator,PNS）联合小剂量丙泊酚用于小儿上肢手术观察其临床效果及不良反应.方法 120 例上肢手术患儿,随机均分为2组.A组（PNS臂丛阻滞加丙泊酚组）：予氯胺酮1 mg·kg-1静脉基础麻醉后,以Winnie法定位前、中斜角肌间隙,PNS辅助定位肌间沟臂丛神经阻滞（0.5%盐酸利多卡因,0.2%罗哌卡因0.8 ml·kg-1,总量不超过20 ml）,术中静脉泵入丙泊酚32.6~41.8 μg·kg-1·min-1;B组（氯胺酮加丙泊酚组）：予丙泊酚1~1.5 mg·kg-1,氯胺酮2 mg·kg-1静脉注射.继之以微泵持续静脉注射丙泊酚41.7~50 μg·kg-1·min-1,氯胺酮33.4~41.7 μg·kg-1·min-1.观察2组生命体征,麻醉起效、苏醒时间,手术时间,麻醉药用量及术后不良反应.结果 2组患者术中生命体征平稳,手术时间无明显差别,但A组患儿苏醒时间明显较B组短,麻醉药用量也小于B组（P〈0.05）,A组术后恶心、呕吐、躁动等发生明显少于B组（P〈0.01）.结论 在小儿上肢手术中应用PNS臂丛阻滞复合小剂量丙泊酚安全可行、副作用小、麻醉恢复快、可控性强.

Objective To investigate the clinical and side effects of brachial plexus block using the peripheral nerve stimulator（PNS） combined with the small dose of propofol for upper extremity surgery in pediatric anesthesia. Methods 120 children undergoing upper extremity surgery were randomly divided into 2 groups with 60 cases each. In group A, the children received ketamine 1 mg . kg- 1 , followed by brachial plexus block using the PNS （0.5 % lidocain hydrochloride, 0.2% ropivacaine 0.8 ml . kg-1, with the total volume less than 20 ml） , and were maintained by a continuous propofol infusion with 32.6 -41.8 μg . kg-1. min-1 ; In group B,the children received propofol 1 - 1.5 mg . kg-1 and ketamine 2 mg. kg-1, maintained by a continuous infusion with 41.7-50 μg .kg-1 . min-1 propofol and 33.4-41.7 μg . kg-1 . min -1 ketamine. Vital signs, operation time, recovery time and side effects were assessed. Results Vital signs of all the children in the 2 groups were both in normal range. There were no difference of the operation time between group A and B. The recovery time in group A was significantly shorter than that in group B （ P 〈 0.05 ）. The patients with postoperative agitation, nausea and vomiting in group A were significantly less than those in group B （ P 〈 0.05 ）. Conclusion In pediatric anesthesia, brachial plexus block using the PNS combined with a small dose of propofol is a safe method, with less side effects, quick recovery and good controllability.