高位肌间沟神经阻滞麻醉的临床应用

Clinical application of superior interscalene nerve block anesthesia

目的:探讨高位肌间沟神经阻滞麻醉应用于上臂、肩部和锁骨手术部位临床麻醉效果。方法:选择锁骨骨折、肩关节复位、肩部及肱骨上段手术61例,依据不同的麻醉方法将其分为A、B两组。A组高位肌间沟神经阻滞麻醉36例,B组常规肌间沟臂丛神经阻滞麻醉25例。观察两组麻醉效果及不良反应。结果:A组高位肌间沟神经阻滞麻醉36例成功率97%,B组常规肌间沟臂丛神经阻滞麻醉25例成功率4%(P<0.01)。结论:高位肌间沟神经阻滞麻醉在锁骨骨折、肩部和上臂手术中麻醉效果完善。前、中斜角肌上端交叉点体表标志明显,定位准确,操作简便,易于成功,不会引起气胸,安全无不良反应。

Objective：To observe the effects applying brachial plexus block by superior interscalenus route to surgery for arm, shoulder and clavicle. Methods ： Sixty-one patients undergone surgery at shoulder, clavi- cle or ann were allocated to either group A or group B on anesthesia ap- proach basis. Group A（ n = 36 ） received brachial plexus block by superior interscalenus route and group B （ n = 25 ） were managed with conventional brachial plexus block. Two groups were observed regarding the analgesic effects and adverse events during the procedure. Results： Analgesia a- chieved in 97% of the patients in group A,whereas it was only 4% in group B（P 〈 0.01 ）. Conclusion： Interscalene nerve block at superior level may lead to perfect analgesia for procedure at the upper arm, shoul- der or clavicle. Evident cross point at the anterior and medial scalenus muscles makes exact identification of the anesthesia location and easy per- formance,yet pneumothorax free, or other adverse events related to anes- thesia.