不同定位方法用于臂丛神经阻滞的临床疗效

Clinical effect of different positioning methods for brachial plexus block

目的 探讨超声引导、神经刺激仪引导和传统解剖定位用于臂丛神经阻滞中的临床疗效。方法 选取2015年6月~2016年3月浙江省衢州市人民医院收治的180例择期行臂丛神经阻滞下上肢手术的患者作为研究对象,按照随机数字表法将患者分为超声引导组1组、超声引导组2组、神经刺激仪1组、神经刺激仪2组、解剖定位1组与解剖定位2组,每组各30例。所有1组均采用0.375%罗哌卡因20 mL进行臂丛神经阻滞,所有2组均采用0.375%罗哌卡因30 mL进行臂丛神经阻滞。比较各组麻醉效果。结果 超声引导组麻醉操作时间和麻醉起效时间明显短于其余各组（P〈0.01）;神经刺激仪组的麻醉起效时间明显短于相同剂量的解剖定位组（P〈0.01）;解剖定位1组麻醉起效时间明显长于解剖定位2组（P〈0.01）;超声引导组阻滞成功率明显高于其余各组（P〈0.01）;超声引导组麻醉并发症发生率分别明显低于相同剂量解剖定位组（P〈0.05）,同时各定位方法 1组麻醉并发症发生率均低于2组,但差异无统计学意义（P〉0.05）。结论 相较于神经刺激仪引导和传统解剖定位,超声引导下臂丛神经阻滞效果更为明显,麻醉起效更快,并发症少;0.375%罗哌卡因推荐应用剂量为20 mL。

Objective To investigate the clinical effect of the ultrasound guided, nerve stimulator guided and traditional anatomic localization for brachial plexus block （BPB）. Methods One hundred and eighty patients undergoing elective BPB for upper limb surgery in Quzhou People＇s Hospital from June 2015 to March 2016 were selected and randomly divided into six groups by random number table： ultrasound guided group one and ultrasound guided group two, nerve stimulation instrument group one and nerve stimulation instrument group two, anatomic location group one and anatom- ic location group two, 30 cases in each group. The 0.375% Ropivacaine dosage of group one and group two for BPB were 20 mL and 30 mL respectively. The anesthetic effects of the six groups were compared. Results The anesthesia operation time and onset time of the ultrasound-guided group was obviously shorter than that in the nerve stimulator group and the anatomic location group （P 〈 0.01）. And the onset time of the nerve stimulator group was shorter than those with the same dose of Ropivacaine of the anatomic location group （P 〈 0.01）. The onset time of group one was significantly longer than those of group two （P 〈 0.01）. The success rate of ultrasound guided group was significantly higher than those of the other groups （P 〈 0.01）. The incidence of anesthesia complications of the ultrasound guidance group was significantly lower than those with the same dose of Ropivacaine of the anatomic location group （P 〈 0.05）. The incidence of anesthesia complications of the group one was lower than those of the group two, but the difference was not statistically significant （P 〈 0.05）. Conclusion The block effect of BPB guided by ultrasound is more obvious than nerve stimulator guided and traditional anatomic localization. Anesthesia works faster and has fewer complications. The clinic recommended dosage of 0.375% Ropivacaine was 20 mL.