超声引导下肌间沟臂丛联合尺神经阻滞在前臂尺侧手术中的应用

Application of Interscalene Brachial Plexus Combined with Ulnar Nerve Block to Operation of Dorsoulnar Forearm Guided by Ultrasound

目的：评价超声引导下肌间沟臂丛联合尺神经阻滞应用于前臂尺侧手术的效果和安全性。方法：选择ASAⅠ~Ⅱ级前臂尺侧手术患者60例,随机分为超声引导下肌间沟臂丛联合腋路臂丛阻滞组（A组）和超声引导下肌间沟臂丛联合尺神经阻滞组（B组）,每组各30例。配制0.5%盐酸罗哌卡因注射液30mL备用。A组患者先行肌间沟臂丛阻滞,超声探头长轴与肌间沟垂直放置,调整探头位置可显示圆形或椭圆形低回声的臂丛神经上、中、下三干,在其周围分别注射局麻药5mL,使局麻药完全包绕在神经干周围。然后行腋路阻滞,超声引导下依次在尺神经、正中神经和桡神经周围各注射局麻药5mL。B组患者先行肌间沟臂丛阻滞,方法同A组,显像臂丛神经上、中、下三干后在其周围注射局麻药共25mL。然后行尺神经阻滞,将超声探头垂直尺神经沟放置于肱骨内上髁近端,可见圆形或椭圆形的低回声图像即为尺神经,在尺神经周围注入局麻药5mL。记录麻醉操作时间和感觉阻滞起效时间;评价手术过程中的麻醉效果满意度;记录并发症的发生情况。结果：两组患者性别比例、年龄、体重、麻醉操作时间均无统计学意义（P〉0.05）;两组患者感觉阻滞起效时间比较,B组起效时间明显短于A组（P〈0.05）;两组患者麻醉效果满意度的比较无统计学意义（P〉0.05）;两组均无Horner综合征、喉返神经阻滞和尺神经卡压征,A组有3例发生兴奋、多语等轻度局麻药中毒症状,B组没有任何并发症。结论：超声引导下肌间沟臂丛联合腋路臂丛阻滞和超声引导下肌间沟臂丛联合尺神经阻滞应用于前臂尺侧手术均可达到满意的麻醉效果,但后者起效更快,安全性更高。

Objective： to evaluate the effects and safety of the application of interscalene brachial plexus combined with ulnar nerve block to operation of dorsoulnar forearm guided by ultrasound. Methods： 60 patients had dorsoulnar forearm operation at ASA Ⅰ ～ Ⅱ level were chosenand randomly divided into two groups A and B,ultrasound guided interscalene and road axillary brachial plexus block（ group A） and interscalene combined with ulnar nerve block of brachial plexus（ group B）,30 cases in each group. 30 ml 0. 5% ropivacaine hydrochloride injection was made. Group A had interscalene brachial plexus block first,the long axis of ultrasound probe was placed perpendicular to the interscalene; probe location was adjusted to show round or oval hypoechoic upper,middle and lower trunk of brachial plexus; 5 m L local anesthetic was injected respectively around the three trunks of brachial plexus to make local anesthetics completely around the nerve trunk. Then the axillary road blocks was performed,in turn guided by ultrasound 5 m L of local anesthetic was injected to the ulnar nerve,median nerve and radial nerves. Group B had interscalene brachial plexus block first just as group A. After the imaging of the upper,middle and lower trunk of brachial plexus 25 m L injection of local anesthetic was injected around the nerve trunk. Then the ulnar nerve block was made,the long axis of ultrasound probe was placed vertically,proximal to the medial epicondyle of the humerus,round or oval hypoechoic image was the ulnar nerve,5 m L injection of local anesthetic was injected around the ulnar nerve. The operation time and sensory block onset time of anesthesia were recorded; the satisfaction of anaesthesia effect during surgical proccess was evaluated; the occurrence of complications was recorded. Results： There had no statistical significance between the sex ratio,age,weight,anesthesia operation time of the two groups（ P﹤0. 05）; The sensory block onset time of the two groups was compared; it was found that Goup B was significantly shorter than Group A（ P﹤0. 05）; The comparison of the satisfaction of Anesthetic effect between the two groups had no statistically significance（ P﹤0. 05）; Two groups had no Horner Syndrome,recurrent laryngeal nerve block and ulnar nerve entrapment. Three cases of group A had mild local anesthetics poisoning ymptom such as excitement,logomania. Group B did not have any complications. Conclusion： The application of ultrasoundguided interscalene brachial plexus block combined with axillary brachial plexus block and with ulnar nerve block to dorsoulnar forearm surgery can achieve the satisfactory anaesthesia effect,but the latter works faster and safer.