不同频率超声及作用时间对超声引导神经阻滞起效和完善的影响

Effects of Different Frequency and Time on the Effects of the Onset and Block of the Nerve Block Guided by Ultrasound

为探讨超声引导联合神经刺激器阻滞技术的起效及完善时间与超声效应的相关性,为临床应用提供依据,将我院2014年1月至2015年12月收治的120例上肢手术患者随机分为4组,即UA组、CUA组、UB组和CUB组,UA组和CUA组在7.5 MHz超声探头引导下利用神经刺激器定位臂丛神经行阻滞,UB组和CUB组在10 MHz超声引导下阻滞,UA组和UB组局麻药注射完毕后即移开超声探头,CUA组和CUB组在各神经阻滞效果完善后移开超声探头;详细记录各组患者的探头接触皮肤时间、注药完毕时间、神经阻滞后的阻滞起效时间和完善时间。研究结果表明,UB组患者超声接触时间显著长于UA组(t=2.765,p=0.009),各组间患者注药时间、感觉阻滞完善时间和运动阻滞完善时间差异无统计学意义(p>0.05);UA组患者腋神经、前壁外侧皮神经、前壁内侧皮神经、尺神经和桡神经支配起效时间显著低于UB组(t=2.492,p=0.018;t=3.017,p=0.005;t=2.072,p=0.045;t=3.249,p=0.003;t=4.444,p<0.001),其余各组间诸神经支配起效时间无显著性差异(p>0.05)。选用高频超声探头联合神经刺激仪引导定位穿刺具有较好的临床应用价值,且超声时间与神经阻滞并无显著相关性。

In order to investigate the onset and improve time of ultrasound guidance combined with nerve stimulator block technique, and the correlation between ultrasonic effect, so as to provide a basis for clinical application. 120 cases of upper limb surgery patients, which were accepted in our hospital from January 2014 to December 2015 were randomly divided into 4 groups, namely the UA group, CUA group, UB group and CUB group. Under the guidance of 7.5 MHz ultrasonic probe, UA and CUA group used nerve stimulator brachial plexus nerve block. UB and CUB group were retardant under the guidance of 10 MHz ultrasound. After the injection of local anesthetic, UA and UB group removed ultrasonic probe quickly. Then in CUA and CUB group, after the improvement of the nerve block effect, they removed the ultrasonic probe. With each patient recorded the probe contact skin time, injection complete time, block onset time and improvement time after the nerve block. The result showed that UB group by ultrasound in patients with contact time was significantly longer than that in the UA group （t=2.765, p=0.009）. Among groups, there was no statistically significance of injection time, sensory block time and difference of motor block improve time （p〉0.05）; Patients UA group with axillary nerve, anterior lateral cutaneous nerve, anterior medial cutaneous nerve, ulnar nerve and radial nerve dominate onset time was significantly lower than that of UB group （t=2.492, p=0.018; t=3.017, p=0.005; t=2.072, p=0.045; t=3.249, p=0.003; t=4.444, p=0.000）. And there were no significant difference among other groups on onset time of nerve innervation （p〈0.05）. The use of high frequency ultrasound probe combined with nerve stimulator guided positioning puncture has a good clinical value, and there was no significant correlation between ultrasound time and nerve block.