三维彩超引导行肌间沟臂丛神经阻滞的临床应用

Clinical Application of Three-Dimensional Color Doppler Ultrasound Guidance in Interscalene Brachial Plexus Block

目的探讨三维彩超引导行肌间沟臂丛神经阻滞用于上肢手术患者的麻醉效果及安全性。方法根据患者上肢手术时接受的麻醉方式,将患者分为彩超定位组(三维彩超引导行肌间沟臂丛神经阻滞)和传统定位组(盲探式臂丛神经阻滞)。两组患者均给予0.375%罗哌卡因+1%利多卡因合剂麻醉。记录所有患者的阻滞定位时间、完成阻滞所需时间、神经阻滞后起效时间、阻滞完善时间、阻滞维持时间,评价麻醉效果和患者的术后并发症。结果彩超定位组的阻滞定位时间、完成阻滞所需时间、神经阻滞后起效时间和阻滞完善时间均明显短于传统定位组,而阻滞维持时间明显长于传统定位组,差异均有统计学意义(P<0.05)。两组患者的麻醉效果和术后并发症差异无统计学意义(P>0.05)。结论通过三维彩超引导行肌间沟臂丛神经阻滞的方式能帮助麻醉师更快和更准确地找到臂丛神经,缩短完成神经阻滞的时间,且维持的时间更长。

Objective To investigate the anesthetic effect and safety of three-dimensional color Doppler ultrasound guided interscalene brachial plexus block for patients with upper limb surgery. Methods According to the anaesthesia modes, the patients were divided into color ultrasound positioning group （three-dimensional color Doppler ultrasound guided interscalene brachial plexus block） and traditional positioning group （blind tracheal interscalene brachial plexus block）. Two groups of patients were given 0.375% ropivacaine and 1% lidocaine for anesthesia. The positioning time of block, time to complete block, oneset time of block, time of completed block and maintenance time of block were recorded, and the anesthesia effects and postoperative complications were evaluated between the two groups. Results The positioning time of block, time to complete block, oneset time of block and time of completed block in color ultrasound positioning group were significantly shorter than those in traditional positioning group, while block maintenance time was significantly longer than that in traditional positioning group, with significantly statistical difference （P〈0.05）. No statistical difference was found between the two groups in anesthetic effects and postoperative complications （P〉0.05）. Conclusions Three-dimensional color Doppler ultrasound guided interscalene brachial plexus block can help to find the brachial plexus faster and more accurately, shorten the completion time of nerve block, and maintain a longer time.