超声引导下老年患者肌间沟臂丛神经阻滞麻醉的临床观察

Clinical observation of ultrasound-guided interscalene brachial plexus block in elderly patients

目的比较超声引导下定位与神经刺激器定位老年患者行肌间沟臂丛神经阻滞麻醉的效果及安全性。方法选择实施上肢手术的70岁以上老年患者36例,ASAⅡ或Ⅲ级,将其按随机数字表法随机分为超声引导下定位(U组)和神经刺激器定位(S组),每组18例,两组均给予0.33%罗哌卡因20 ml,记录两组阻滞麻醉操作所需时间、一次穿刺成功率、穿刺误入血管次数、感觉神经阻滞麻醉起效时间、麻醉效果及辅助用药例数,观察并记录并发症发生率。结果 U组完成操作所需时间为(4.5±1.2)min,明显短于S组的(8.1±2.5)min(P<0.01)。U组一次穿刺注射成功率明显高于S组,U组穿刺误入血管次数和辅助用药例数明显低于S组,U组感觉阻滞起效时间(8.2±2.4)min,明显快于S组(13.1±2.5)min(P<0.05)。两组麻醉效果比较,差异无统计学意义(P>0.05)。S组有1例发生局麻药中毒反应。结论超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,并发症少,用于老年患者安全、有效。

Objective To obverse the clinical application of interscalene brachial plexus block to elderly patients by uhrasound- guided technique and nerve stimulator-guided technique. Methods Thirty-six elderly patients （ ASA Ⅱ - Ⅲ ） undergoing operation in upper extremities were randomly divided into two groups, i.e. Group U （ n = 18, ultrasound-guided technique） and Group S （ n = 18, nerve stimulator-guided technique）. Ropivacaine （0.33% , 20ml） was applied to each group. We recorded operation time, success rate of one time puncture, number of times of mis-puncture into blood vessel, beginning time of sensory block, anesthetic effect and case number of adjuvant drug, as well as complication. Results The time needed to complete the operation was significantly shorter in Group U （4.5 ± 1.2 min） than in Group S （8.1 ± 2.5 min） （ P 〈 0.01 ）. The success rate of one time puncture was significantly higher in Group U than in Group S, the number of times of mis-puncture into blood vessel and the case number of adjuvant drug were significantly shorter and fewer in Group U than in Group S, and the beginning time of sensory block was significantly earlier in Group U （8.2 ±2.4 min） than in Group S （ 13.1 ±2.5 rain） （P 〈0.05）. There was no significant difference in anesthetic effect between the two group, and local anesthetic toxic reaction occurred in one case in Group S. Conclusion Ultrasound-guided interscalene brachial plexus block has the advantage of short operating time, fast block and few complications. Its application to elderly patients is safe and effective.