超声联合神经刺激仪引导锁骨上臂丛神经阻滞在小儿上肢手术的应用

Application of ultrasound combined nerve stimulation supraclavicular brachial plexus blockage in pediatric upper extremity operation

目的探讨超声联合神经刺激仪引导下锁骨上臂丛神经阻滞用于小儿上肢手术的效果。方法选取择期行上肢手术患儿40例,随机分为超声联合神经刺激仪组(A组)和神经刺激仪组(B组)各20例。两组患儿均在七氟醚或及笑气吸入诱导后置入喉罩下行锁骨上臂丛神经阻滞,A组采用超声辅助神经刺激仪定位;B组仅采用神经刺激仪定位,定位成功后注入0.5%罗哌卡因≤0.5mL/kg。比较两种麻醉方法的神经定位和起效时间、镇痛维持和恢复室停留时间、术中辅助药用量及麻醉并发症的发生情况。结果 A组神经定位、麻醉起效及恢复室停留时间[(4.3±0.7)min,(5.4±1.2)min,(24.5±6.3)min]明显短于B组[(7.5±0.8)min,(7.7±2.3)min,(31.6±7.4)min)];术中辅助用药也明显少于B组,其差异均有统计学意义(P<0.05);A组镇痛维持时间明显长于B组[(394.3±32.6)min vs(312.8±30.4)min];A组罗哌卡因和术中辅助用药量[(8.7±2.4)mL,(15.7±4.3)mg)]也明显少于B组[(11.8±2.6)mL,(20.8±6.4)mg)];术中麻醉效果A组明显优于B组,而误穿血管的发生率则比B组低(P<0.05)。结论超声联合神经刺激仪引导下锁骨上臂丛神经阻滞用于小儿上肢手术可明显提高麻醉效果,减少麻醉并发症,可安全用于临床。

Objective To investigate the ultrasound combined nerve stimulation supraclavicular brachial plexus anaesthe‐sia for safe and effective operation of the upper limbs in children .Methods Forty patients undergoing upper limb operation were randomly divided into the ultrasound combined nerve stimulation group （group A） and nerve stimulation group （group B） ,with 20 patients in each group .The two groups of children had the sevoflurane/N2 O inhaled anesthesia supraclavicular brachial plexus blockage ,but those in group A were ultrasound combined nerve stimulation ,while those in group B were with nerve stimulator , 0.5% ropivacaine ≤0.5 mL/kg concentration was used for nerve blockage .The handling time ,onset time of nerve block ,block duration time and the time spent in the recovery room ,drug dosage for intra-operative assistance ,the effect of anesthesia and the complications of the two group were compared .Results The handling time ,onset time and time spent in the recovery room in group A was significantly shorter than those in group B （P〈0.05） .The drug used for anesthesia assistance in group A was less than group B （P〈 0.05） .The block duration time of group A was significantly longer than that of group B （P〈0.05） ,and the anesthesia effect during the surgery of group A was better than group B .The incidence of vascular injury in group B was higher than that of group A ,（P〈0.05 ） .Conclusion Ultrasound combined nerve stimulation supraclavicular brachial plexus blockage can obviously improve the anesthetic efficacy ,reduce the complications of anesthesia in children for upper limbs opera‐tion .It can be safely used in clinical practice .