神经刺激仪引导下肌问沟臂丛联合尺神经阻滞与腋路臂丛神经阻滞的效果比较

目的比较神经刺激仪引导下肌间沟臂丛联合尺神经阻滞与腋路臂丛神经阻滞的麻醉效果。方法选择ASAI～Ⅱ级断掌或断腕再植患者80例，按随机数字表法均分为两组，每组40例，在神经刺激仪引导下行神经阻滞，I组采用肌间沟臂丛联合尺神经阻滞，Ⅱ组采用腋路两点臂丛神经阻滞。记录两组患者桡神经、正中神经、尺神经阻滞起效时间、维持时间、止血带耐受情况，以及膈神经阻滞、霍纳综合征、喉返神经阻滞等并发症。结果I组桡神经、正中神经、尺神经阻滞起效时间[（5．13±0．76）、（7．13±1．04）、（3．23±0．62）mini均明显快于Ⅱ组[（9．234-1．61）、（12．35±1．76）、（8．83±1.13）min]，差异有统计学意义（P〈0．05），两组阻滞维持时间比较差异无统计学意义（P〉0．05）。I组桡神经、正中神经、尺神经感觉阻滞优秀率[90．0％（36／40）、85．0％（34／40）、97．5％（39／40）]均明显高于Ⅱ组[72．5％（29／40）、65．0％（26／40）、70．0％（28／40）]，差异有统计学意义（P〈0．05）。I组桡神经、正中神经、尺神经运动阻滞完全率[75．0％（30／40）、37．5％（27，40）、80．O％（32／40）]均明显高于Ⅱ组[47．5％（19／40）、40．0％（16／40）、45．O％（18／40）]，差异有统计学意义（P〈0．05）。I组止血带耐受优秀率[90．0％（36／40）]高于Ⅱ组[62．5％（25／40）]，差异有统计学意义（P〈O．05）。I组膈神经阻滞2例，霍纳综合征1例。两组均无喉返神经阻滞发生。结论神经刺激仪引导下肌间沟臂丛联合尺神经阻滞起效快，感觉、运动阻滞效果好，提高止血带的耐受率且不增加不良反应，更适合长时间的手、腕部显微外科手术。

Objective To compare the anesthetic effects of interscalene brachial plexus combined with ulnar nerve and axillary brachial plexus block guided by nerve stimulator. Methods Eighty patients belonging to ASA ⅠorⅡ and undergoing replantation of severed palm or wrist were divided randomly into 2 groups, Each group had 40 patients. Nerve stimulator guided nerve block. Patients in groupⅠreceived interscalene brachial plexus combined with ulnar nerve block, and those in groupⅡreceived axillary brachial plexus block. The onset time, hold time, tourniquet tolerance of radial nerve, median nerve and ulnar nerve of two groups was recorded. The phrenic nerve block, Horner′s syndrome and recurrent laryngeal nerve block was compared between two groups. Results The onset time of radial nerve, median nerve and ulnar nerve in group Ⅰwas (5.13 ± 0.76), (7.13 ± 1.04), (3.23 ± 0.62) min , in group Ⅱ was (9.23 ± 1.61), (12.35 ± 1.76), (8.83 ± 1.13) min, and there were significant differences (P<0.05). The excellent rates of sensory block of radial nerve, median nerve and ulnar nerve in group Ⅰ were 90.0%(36/40), 85.0%(34/40), 97.5%(39/40), in group Ⅱ were 72.5%(29/40), 65.0%(26/40), 70.0%(28/40), and there were significant differences (P<0.05). The full rates of motor block of radial nerve, median nerve and ulnar nerve in groupⅠwere 75.0%(30/40), 37.5%(27/40), 80.0%(32/40), in groupⅡ were 47.5%(19/40), 40.0%(16/40), 45.0%(18/40), and there were significant differences (P < 0.05). The tourniquet tolerance rate in group Ⅰwas significantly higher than that in groupⅡ:90.0%(36/40) vs. 62.5%(25/40) , P<0.05. In groupⅠ, phrenic nerve block occurred in 2 patients, and Horner syndrome occurred in 1 patient. None had laryngeal recurrent nerve block in both group. Conclusions The interscalene brachial plexus combined with ulnar nerve block guided by nerve stimulator is more suitable for a long time microsurgery of the palm or wrist, because it takes action faster, has better sensory and motor block effects, improves the rate of tourniquet tolerance without increasing untoward reaction.