肌间沟和腋路联合阻滞在上肢手术的临床应用

Application of Interscalene Combined with Axillary Approach in Upper Limb Operation

目的:比较臂丛神经两点阻滞和单点阻滞用于上肢手术的阻滞效果和不良反应。方法:90例手术患者,ASAⅠ-Ⅱ级,手术时间1-5h,按随机双盲法抽取手术中的1/3病例分为三组,每组30例。A组:同侧肌间沟20ml(0.375%罗哌卡因+1%利多卡因)联合腋路15ml(0.375罗哌卡因+1%利多卡因)阻滞;B组:肌间沟阻滞组;C组:腋路阻滞组,均单次注射35ml。比较三组间阻滞效果,阻滞时间和不良反应。结果:两点阻滞法对尺桡侧神经阻滞较完善(p<0.05),阻滞时间明显延长(p<0.05),能较好地满足手术要求,不良反应发生率不增加(p>0.05)。结论:等浓度等剂量的药物浓度行臂丛神经两点阻滞效果优于单点阻滞法,不增加不良反应率,较适合用于上肢手术。

Objective： To compare the blocking effects and adverse effects of brachial plexus 2 points block and single point block in upper limb operation. Methods： 90 ASA I - II patients who received operation （1 -5h） were divided into three groups （30 cases in each group） by a random double blind method. Group A： patients were treated with ipsilateral tendon groove 20ml （0. 25% of ropivacaine ＋ 1% of lidocaine） combined with axillary road （15ml） block; Group B： patiens were treated with tendon ditch block 35ml Group C： patients were treated with axillary road block （35ml）. The blocking effects, blocking time and adverse offects were compared among the three groups. Results The blocking effects of brachial plexus 2 points block on the ulnar and radial sensory and motor never was better （ p 〈 0. 05）, the blocking time was delayed obviously （ p 〈 0. 05）, The brachial plexus 2 points block met requirements of operation better and no increasing the incidence of adverse reactions. Conclusion： The brachial plexus 2 points block advances more than the single point block, and doesn＇ t increase the incidence of adverse reactions, therefore it is more suitable for upper limb operation.