超声引导与联合神经刺激器定位行腋入路臂丛神经阻滞的效果比较

Comparison of blockage effect of axillary brachial plexus block between ultrasound guidance alone and ultrasound guidance plus neurostimulation

目的观察腋入路臂丛神经阻滞时，单独使用超声引导能否达到与联合应用神经刺激器时相同的阻滞效果。方法经医院伦理委员会批准，选取北京积水潭医院手外科2011年1至5月，拟于腋入路臂丛神经阻滞下行手、前臂及上肢远端手术患者166例，按计算机生成随机数字表随机分为2组：超声引导联合神经刺激器定位组（uS—Ns）、超声引导组（US）；分别定位尺、正中、桡和肌皮神经，每支神经周围注射0．5％罗哌卡因10ml。观察比较阻滞操作时间，进针次数，阻滞成功率，阻滞完善时间，并发症（刺破血管，急性神经损伤，止血带痛等）及患者满意度。结果US组操作时间明显短于US—NS组[（3．3±1．5）min比（5．3±2．0）min，P〈0．01]。US组进针次数明显少于US—NS组[（4．3±0．7）次比（5．6±1．4）次，P〈0．01]。两组阻滞成功率比较差异无统计学意义。US-NS组阻滞完善时间短于US组[（10．6±6．4）min比（12．7±6．9）min，P〈0．05]。US—NS组刺破血管比例显著高于US组（16／83比1／83，P〈0．01）。两组患者均未出现止血带痛，满意度差异无统计学意义。结论超声引导下腋人路臂丛神经阻滞，无论是否联合应用神经刺激器，均可获得完善的阻滞效果；单独超声引导腋路臂丛神经阻滞的并发症率似乎低于联合神经刺激器组。

Objective To compare the blockage effect of multiple injection axillary brachial plexus blockage between ultrasound guidance alone and ultrasound guidance plus neurostimulation. Methods Upon the approval of institutional ethical committee, a total of 166 patients underwent hand, forearm and distal arm operations under axillary braehial plexus blockage from January to May in 2011 at Department of Hand Surgery, Beijing Jishuitan Hospital. They were randomly allocated to receive either ultrasound guidance plus nerve stimulation （group US-NS, n = 83 ） or ultrasound guidance alone （group US, n = 83 ） for nerve localization. Ten milliliter ropivacaine 0.5% was administered separately on each nerve. Blockage time, needle frequency, success rate, onset of sensory and motor blocks, procedure-related complications （vascular puncture, acute nerve injury and tourniquet pain, etc. ） and patient satisfaction were recorded. Results The procedure time was shorter in US group than in US-NS group [ （3.3 ± 1.5 ） vs （5.3± 2.0） min, P 〈 0. 01 ]. The median （range） number of needle frequency of group US was lower than that of group US-NS [ （4.3 ±0.7） vs （5.6 ±1.4） temps, P 〈0.01 ]. No intergroup difference existed in success rate. The onset of complete block was shorter in group US-NS than that in group US [ （ 10.6 ± 6.4） vs （ 12.7 ± 6.9） min, P 〈0.05]. Vascular puncture proportion was higher in group US-NS than group US （16/83 vs 1/83, P 〈 0. 01 ）. There was no occurrence of tourniquet pain. Patient acceptance was similar in two groups. Conclusion Multiple injection axillary blockage with ultrasound guidance yield similar success rates whether or not combined with nerve stimulation guidance. There appears to be a lower incidence rates of complications for ultrasound guidance alone versus ultrasound guidance plus neurostimulation.