神经刺激器引导下两点法颈丛加臂丛神经阻滞的效果观察

Clinical Effects of Nerve-Stimulator-Guided Cervical Plexus and Brachial Plexus Block by Two-Point Injection

目的比较神经刺激器引导下不同剂量舒芬太尼复合罗哌卡因两点法颈丛加臂丛神经阻滞的效果和并发症发生情况。方法将200例择期行锁骨骨折内固定手术的病人随机分为A、B、C、D4组,每组50例,均选用0.375%罗哌卡因30ml在神经刺激器引导下实施两点法颈丛加臂丛神经阻滞(颈4横突和颈5横突水平,每个穿刺点注入局麻药15ml),A组0.375%罗哌卡因30ml,B组药液中加入舒芬太尼0.1μg/kg,C组药液中加入舒芬太尼0.2μg/kg,D组药液中加入舒芬太尼0.3μg/kg。麻醉实施后,观察并记录C4(第4颈神经)、C5(第5颈神经)支配区域感觉阻滞(针刺法)的起效时间和完善时间、运动阻滞完善时间、镇痛的持续时间和并发症的发生情况。结果麻醉前后4组患者生命体征差异无统计学意义(P>0.05)。4组受试者感觉阻滞起效时间、感觉阻滞完善时间、运动阻滞完善时间差异无统计学意义(P>0.05)。C、D组镇痛持续时间较A、B组明显延长,差异有统计学意义(P<0.05)。麻醉后10～20minC、D组Ramsay镇静评分高于A、B组,差异亦有统计学意义(P<0.05)。结论 0.2μg/kg舒芬太尼复合罗哌卡因30ml是成人神经刺激器引导下两点法颈丛加臂丛神经阻滞的合适剂量。

Objective To evaluate the efficacy of nerve-stimulator-guided cervical plexus and brachial plexus block by Two-point Injection using ropivacaine combined with different doses of sufentanil. Methods A total of 200 adult patients undergoing Internal Fixation of Clavicle Fracture were allocated randomly to receive cervical plexus and brachial plexus block using 30 ml of 0.375% ropivacaine （group A）, 30 ml of 0.375% ropivacaine combined with sufentanil 0.1 Ixg/kg （group B）, 30 ml of 0.375% ropivacaine combined with sufentanil 0.2 I^g/kg （group C）, and 30 ml of 0.375% ropivacaine combined with sufentanil 0.3 I^g/kg （group D）. There were 50 patients in each group. All patients received nerve-stimulator-guided cervical plexus and brachial plexus block at C4,C5. 15ml of local anesthetics were injected into each point （Ca and C5）. The onset time and sufficient time of sensory and motor block, duration of analgesia and complications were recorded. Results The vital signs （MAP, HR and SpO2） of the four groups were stable, and there was no significant difference before and after injection （P〉O.05）. The onset time and sufficient time of sensory block and motor block were compared among four groups（P〉0.05 ）. The duration of analgesia in group C and D tended to be longer than the group A and B （P〈0.05）. Ramsay sedation scales obtained in group C and D after injection for 10-20 min were higher than group A and B （P〈O.05）. Conclusion Ropivacaine （30 ml） combined with sufentanil （0.2 pLg/kg） may be suitable for nerve-stimulator-guided cervical plexus and brachial plexus block in adult patients.