5%葡萄糖溶液与无菌注射用水用于扩张小儿神经外周间隙效果的比较

Comparison of 5% dextrose water used in expanding perineural space compared with sterile water

目的验证无菌注射用水是否可用于在外周神经阻滞操作中扩开神经外周间隙,且其在帮助神经定位及保护神经方面是否优于传统方法的5%葡萄糖溶液。方法选取60例需在肌间沟神经阻滞下接受上肢手术的患儿,随机分成两组:5%葡萄糖溶液组(G组)和无菌注射用水组(S组),每组30例。先记录在某一位置下获得神经冲动的最小刺激电流强度(minimal intersity of stimulation,MIS)以及人体电阻(human body resistance,HBR),然后注入5%葡萄糖溶液或者无菌注射用水5 mL,再次记录获得与注射前相同肌肉震颤下的MIS和HBR。分别比较两组患儿注射两种液体前后的MIS及HBR。结果 G组和S组在注射相应的液体后,引发神经冲动所需要的MIS较注射前均减少,且差异有显著统计学意义(P=0.003和P=0.001);而HBR较注射前均增大,差异有统计学意义(P均<0.01)。比较G组和S组之间注射液体后MIS的减少值和HBR的增大值,差异无统计学意义(P=0.405和P=0.533)。结论无菌注射用水可减少神经刺激器所需要释放的MIS,可用于在外周神经阻滞操作中扩开神经外周间隙,其在帮助神经定位、保护神经方面与传统的5%葡萄糖溶液的效果无明显差异。

Objective To prove whether sterile water could be used in expanding perineural space in peripheral nerve block, and whether the sterile water is superior to 5% dextrose water in helping locating and protecting nerve. Methods Sixty patients who were about to undergo surgeries on upper limb were assigned randomly to one of two groups： 5% dextrose water group （G group） and sterile water group （S group）, each group including 30 patients. We tried to find the minimal current that could elicit an evoke motion response in someplace and record the current intensity as the minimal intensity of stimulation （MIS） and the human body resistance （HBR）. After the injection of 5% dextrose water （5 mL） or sterile water （5 mL） ,we adjusted the nerve stimulator as far as the muscle appeared the same amplitude of tremor as before the injection, recorded the MIS and the HBR again, and then compared the MIS and HBR either before and after the injection and between G group and S group. Results After the injection of 5% dextrose water or sterile water,the MIS of G groups and S groups were both significant decreased compared with the MIS before the injection （P = 0. 003 and P = 0. 001）,and the HBR of two groups were both significant higher than the HBR before the injection （P〈0.01）. After the injection,no significant difference was observed in both changes of MIS and HBR in two groups （P = 0. 405 and P = 0. 533）. Conclusions The sterile water can be used in expanding the perineural space like to reduce the MIS of nerve stimulator. There was no significant difference in helping locating and protecting nerve between 5% dextrose water and sterile water.