超声引导及神经电生理监测下小儿臂丛神经阻滞64例临床观察

Clinical observation of brachial plexus block in children under the guidance of ultrasound and the examination of nerve electrophysiology: 64 cases

目的探讨超声引导小儿臂丛神经阻滞的临床特点。方法 128例行切开复位内固定手术治疗的前臂闭合尺桡骨骨折患儿随机分为US、T两组,每组64例。US组于超声引导下实施臂丛神经阻滞,T组采用传统盲探法引导。采用神经电生理监测两组患儿注药10 min后臂丛神经的阻滞情况,对比两组患儿麻醉操作完成时间、麻醉术中全麻药的用量、术后麻醉恢复室停留时间及并发症。结果注药10 min后,US组患儿正中神经、桡神经、尺神经、肌皮神经完全阻滞情况均优于T组(P<0.05);与T组比较,US组操作耗费时间较长、全麻药用量较少,术后苏醒时间较短,苏醒期躁动少(P<0.05)。结论超声引导下小儿臂丛神经阻滞,虽然操作耗时较长,但阻滞成功率高、全麻药用量少、恢复时间短、并发症少。

Objective To investigate the clinical characteristics of brachial plexus block（BPB） for children under the guidance of ultrasound and the monitoring of nerve electrophysiology. Methods 128 sick children with closed radius and ulnas fracture that underwent open operation and internal fixation were randomly divided into Group US and Group T, 64 cases in each group. Group US received BPB under the guidance of ultrasound and Group T underwent traditional blind exploration. Electrophysiological examination was used to monitor the circumstance of brachial plexus block of the two groups 10 min after drug injection. The completion time of anesthetic operation, the dose of general anesthetics in anesthesia and the length of postoperative stay in anesthetic recovery room and complications were compared between the two groups. Results After drug injection for 10 min, the complete block in median nerve, radial nerve, ulnar nerve and musculocutaneous nerve of Group US were superior to those of Group T（P〈0.05）; Compared with Group T, Group US took a longer time, used less dose of general anesthetics, had a shorter recovery time and was less dysphoria（P〈0.05）. Conclusion Although BPB for children under the guidance of ultrasound takes a longer time, it has the characteristics of high successful rate, less dose of general anesthetics, shorter recovery time and less complications.