超声引导行喙突旁入路与腋入路臂丛神经阻滞效应的比较

Comparison of the impact of ultrasound-guided brachial plexus block with subclavian coracoid approach and axillary approach

目的比较超声引导行锁骨下喙突入路与腋入路臂丛神经阻滞在前臂手术中的麻醉效应。方法 100例拟在臂丛神经阻滞下行前臂和手部手术的患者随机分为锁骨下喙突入路组(A组,n=50)和腋入路组(B组,n=50),A组采用超声引导在锁骨下喙突旁定位臂丛神经,B组在腋窝处定位臂丛神经,分别注入0.5%罗哌卡因30 ml。阻滞后每隔5 min评价上肢正中神经、尺神经、桡神经、肌皮神经、臂内侧皮神经、前臂内侧皮神经、腋神经7支终末神经的感觉运动阻滞情况及不良反应发生率。结果 30 min时A组腋神经感觉阻滞完善率明显高于B组(P<0.01),正中、尺、桡、肌皮、臂内侧皮神经、前臂内侧皮神经在各时间段两组感觉阻滞完善率差异无统计学意义(P>0.05),阻滞后15 min,A组患者运动阻滞完善率明显高于B组(P<0.01),阻滞后30 min,两组患者运动阻滞完善率差异无统计学意义(P>0.05)。两组患者均未见不良反应。结论超声引导下锁骨下喙突入路法臂丛神经阻滞成功率高,阻滞效果确切,并发症少,优于常规腋入路臂丛神经阻滞。

Objective To compare the anaesthetic effect of the ultrasound-guided brachial plexus block by subclavian coracoid approach with axillary approach.Methods One hundred patients,who underwent forearm or hand surgery under the brachial plexus block,were randomly divided into the subclavian coracoid approach group（group A,n=50） and axillary approach group（group B,n=50）.Under ultrasound-guidance,30 ml of 0.5% ropivacaine was injected around the subclavian or axillary artery to block the brachial plexus.After the blockade,the sensation and motor blockade of the median nerve,ulnar nerve,radial nerve,musculocutaneous nerve,medial cutaneous nerve,forearm medial cutaneous nerve and axillary nerve were evaluated every 5 min.The rate of complications was also recorded.Results After 30 min,the sensory blockade rate of axillary nerve in group A was significantly higher than that of group B（P 〈0.01）.At other timepoints,the sensory blockade rate of the median nerve,ulnar nerve,radial nerve,musculocutaneous nerve,medial cutaneous nerve and forearm medial cutaneous nerve in group A and group B had no significant difference（P〉 0.05）.After 15 min,the motor blockade rate in group A was significantly higher than that of group B（P 〈0.01）.After 30 min the rate of motor blockade had no significant difference（P 〉0.05）.Conclusion The ultrasound-guided brachial plexus block through coracoid approach has a high rate of success and few complications.