经皮超声引导锁骨上臂丛神经阻滞在学龄前儿童上肢手术的应用

Application of Ultrasound Guidance for Supraclavicular Brachial Plexus Block During Upper Extremity Surgery of Preschool Children

目的 评估经皮超声引导锁骨上臂丛神经阻滞在学龄前儿童上肢手术的麻醉效果。方法 选择60例ASA Ⅰ~Ⅱ级择期行单侧上肢手术患儿,随机分为经皮超声引导锁骨上臂丛神经阻滞组（U组）和体表定位锁骨上臂丛神经阻滞组（B组）。局麻药为0.2%盐酸罗哌卡因（0.5ml/kg）。两组患儿行神经阻滞前均给予右美托咪定负荷剂量1μg/kg镇静,术中0.2-0.7μg/（kg·h）维持。监测两组患儿围术其心率（HR）、平均动脉压（MAP）、心电图（ECG）、呼吸频率（RR）和脉搏血氧饱和度（SpO2）,并记录量化麻醉效果、FLACC疼痛评分以及外科医生和患儿家属的满意程度。结果 两组患儿在麻醉诱导后HR均出现明显降低（P〈0.05）,U组患儿在术后2和4h的疼痛评分低于B组（P〈0.05）,U组患儿家属满意度评分高于B组（P〈0.05）。结论 经皮超声引导锁骨上臂丛神经阻滞应用于学龄前儿童上肢手术可减轻患儿术后疼痛,麻醉质量和安全性高,家属满意度好,值得在小儿临床臂丛神经阻滞中推广应用。

Objective To evaluate the efficacy of ultrasound guidance for supraclavicular brachial plexus block plus dexmedetomidine during upper extremity surgery of preschool children. Methods Sixty children with ASA status Ⅰ-Ⅱand scheduled for upper extremity surgery were randomly assigned to brachial plexus block with ultrasound guidance group （n=30） and brachial plexus block with body surface location （n=30）. 0.2% ropivacaine with amount of 0.5ml/kg was used for brachial plexus block. Before nerve block, both groups recived 1μg/kg dexmedetomidine for induction and matained in 0.2-0.7μg/（kg·h）. During perioperative period, heart rate （HR）, mean arterial blood pressure（MAP）, electrocardiography（ECG）, respiratory rate（RR）and oxygen saturation（SpO2）were monitored, and the adverse events, face legs activity cry consolability （FLACC） score and the degrees of parent and doctor＇s satisfaction were also recorded. Results HR was significantly lower in both groups after induction （P〈0.05）.The pain scores at 2 and 4h postoperation in group U was significantly lower than those in group B （P〈0.05）.The degree of parental satisfaction was significantly higher in group U （P〈0.05）. Conclusion The method of ultrasonic guidance for supraclavicular brachial plexus block plus dexmedetomidine is efficacious in reducing the occurrences of postoperative pain of preschool children, featured with high anaesthsia and safety, and is worth popularizing.