不同径路臂丛神经麻醉对术中止血带反应效果的比较

Comparative Study of Using Different Pathways in Branchial Plexus Blocking Anesthesia on Tourniquets' Side Effects during Surgeries

目的：探讨在显微手外科手术中不同径路臂丛神经麻醉对术中上肢止血带反应效果的比较。方法：120例ASAⅠ~Ⅱ级手部显微手术患者,随机分为三组,采用神经刺激器辅助定位下三种不同径路臂丛神经阻滞,Ⅰ组单纯肌间沟法、Ⅱ组单纯腋路法和Ⅲ组肌间沟联合腋路法,使用药物为0.5%罗哌卡因30ml。每组止血带控制压力为270mmHg,手术每1h放松10min后再充气继续手术。观察并记录麻醉起效时间、麻醉效果、臂丛并发症、止血带反应的发生例数及止血带充气满1h放气前患者的VAS评分。结果：Ⅲ组感觉、运动阻滞起效时间明显短于Ⅰ组、Ⅱ组,明显缩短了手术等待时间（P〈0.05）。Ⅲ组麻醉效果优良率达100%,术中无止血带疼痛反应发生,100%患者VAS评分≤3。结论：肌间沟联合腋路臂丛神经阻滞麻醉在复杂显微手外科手术时,麻醉效果安全可靠,镇痛效果良好,有效预防止血带反应。

Objective：To investigate the effects of using different pathways in branchial plexus blocking anesthesia on tourniquets’ side effects during surgeries.Methods：120 ASA Ⅰ~Ⅱ patients were randomly divided into 3 groups with 40 cases each. neuro stimulator were used to help position their lower brachial plexus nerve blocking with the use of 30ml 0.5% ropivacaine.Interscalene for group Ⅰ,axillar for group Ⅱ,and both interscalene and axillar for group Ⅲ.All groups used 270mmHg as the tourniquet’s control pressure.Every hour during surgeries,the tourniquet was inflated again after the pressure was released for 10 minutes.The starting time of the anesthesia,the effects of the anesthesia,the complication of brachial plexus,the number of tourniquet side effects,and VAS score of the patients right before the pressure of the tourniquet was released were recorded.Results：The starting time of motion blocking of group Ⅲ is much shorter than that of group Ⅰ and group Ⅱ and therefore the waiting time during surgeries is significantly reduced（P〈0.05）.The successful rate of group Ⅲ is 100% with no painful side effects caused by tourniquets during surgeries.Conclusion：Interscalene and axillar as pathways in branchial plexus blocking anesthesia is a safe technique in its analgesic and sedative effects,and it can also effectively prevent the negative side effects caused by tourniquets.