神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者的临床观察

Clinical observation of interscalene joint axillary brachial plexus block guided by nerve stimulator in elderly patients

目的 比较常规异感法和神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者上肢手术的麻醉效果.方法 将60例ASA分级Ⅱ～Ⅲ级择期行上肢手术的高龄患者按随机数字表法分为神经刺激仪组和异感法组,每组30例.神经刺激仪组采用神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞,异感法组按常规异感法行肌间沟联合腋路臂丛神经阻滞.两组所用局部麻醉药均为0.375％罗哌卡因,剂量为0.4 ml/kg.两组肌间沟、腋路臂丛神经阻滞麻醉药剂量各半.观察和记录两组患者操作时间、阻滞起效时间、镇痛持续时间、术中麻醉效果[采用疼痛视觉模拟量表（VAS）评分法]和不良反应.结果 神经刺激仪组操作时间和阻滞起效时间明显短于异感法组[（5.2±1.7） min比（8.6±2.2） min和（19.4±3.2） min比（29.0±3.9） min],术中VAS评分明显低于异感法组[（0.7±0.4）分比（2.3±0.8）分],差异均有统计学意义（P＜0.01）；神经刺激仪组和异感法组镇痛持续时间比较差异无统计学意义[（12.4±3.6）h比（13.1±3.8）h,P＞0.05].神经刺激仪组无不良反应；异感法组有5例发生不良反应,其中局部血肿2例,喉返神经麻痹1例,霍纳综合征2例.结论 神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者定位准确,成功率高,麻醉效果好,不良反应少,值得在临床中推广.

Objective To compare the anesthetic effect of interscalene joint axillary brachial plexus block guided by nerve stimulator or conventional paresthesia in elderly patients with upper extremity surgery.Methods Sixty cases of ASA grade Ⅱ-Ⅲ elderly patients with upper extremity surgery were divided into two groups by random number table.Nerve stimulator group （30 cases） received interscalene joint axillary brachial plexus block guided by nerve stimulator.Paresthesia group （30 cases） received interscalene joint axillary brachial plexus block guided by conventional paresthesia.Both groups used the same local anesthetic：0.375% ropivacaine,the dosage was 0.4 ml/kg.Anesthetic dose between interscalene and axillary in two groups in half.The operating time,block onset time,duration of analgesia,anesthetic effect [used by visual analogue scale （VAS） scores] and adverse reaction in two groups were observed and recorded.Results The operating time and block onset time in nerve stimulator group were significantly shorter than those in paresthesia group[（5.2 ± 1.7） min vs.（8.6 ± 2.2） min and （19.4 ± 3.2） min vs.（29.0 ± 3.9） min],VAS scores was lower than that in paresthesia group [（0.7 ± 0.4） scores vs.（2.3 ± 0.8） scores],there were significant differences （P 〈 0.01）.There was no significant difference in duration of analgesia between two groups [（12.4 ± 3.6） h vs.（13.1 ± 3.8） h,P 〉0.05].Nerve stimulator group without adverse reactions.Paresthesia group had 5 cases of adverse reactions,including local hematoma in 2 cases,laryngeal recurrent nerve paralysis in 1 case,horner syndrome in 2 cases.Conclusion Interscalene joint axillary brachial plexus block guided by nerve stimulator in elderly patients is accurate positioning,high success rate,good anaesthesia effect,less adverse reaction,and worth promoting in clinical.