超声引导下臂丛神经上干阻滞的临床应用

Clinical practice of ultrasound-guided upper trunk block of brachial plexusa

目的:利用超声引导定位臂丛神经上干,在其周围注射局麻药,观察上肢近远端关节阻滞效果,实施精准麻醉。方法:选择60例ASAⅠ~Ⅱ级行相应部位手术的患者,随机分为盲探异感组(BP组)和超声引导组(UG组),每组30例,BP组根据解剖定位行肌间沟穿刺阻滞,患者诉异感后注射0.25%罗哌卡因30 ml,UG组在超声引导下定位臂丛神经,在上干周围注射注入0.25%罗哌卡因20 ml。观察两组患者手术部位2、10 min后痛觉(VAS评分)减退情况,及术毕肩肘关节、腕关节运动阻滞程度。结果:与BP组相比,UG组在使用更少的局麻药的情况下麻醉效果好(P<0.001),VAS评分分别为3.53±1.01(2 min BP组)、1.63±0.89(2 min UG组),1.90±0.93(10 min BP组)、0.53±0.73(10 min UG组)。肩关节、肘关节阻滞程度相似(P>0.05),肩关节肌力评分0.93±0.91(BP组)、0.73±0.74(UG组),腕关节运动阻滞程度轻(P<0.01),腕关节肌力评分为2.70±0.65(BP组)、3.13±0.73(UG组)。结论:超声引导下臂丛神经上干阻滞可满意地用于肩关节、上臂手术的麻醉,减少了局麻药的用量,提高了麻醉效果,并减轻了对远端关节的阻滞程度,利于患者康复。

Objective： To perform the procedure of precision anesthesia through the way of locating the upper trunk of the brachial plexus,then injecting local anaesthetic around it with the help of ultrasound,and observe the clinical effect of the procedure.Methods： 60 ASAⅠ-Ⅱpatients were randomly divided into two groups,the blind puncture paresthesia （BP） group and the ultrasound-guide （UG） group,30 patients in each group.30 ml 0.25%ropivacaine was injected in BP group after locating the brachial plexus by landmarks and complains of paresthesia;20 ml 0.25% ropivacaine was injected in UG group after locating the upper trunk of the brachial plexus by ultrasound.Then the degree of pain were scored by visual analogue scale （VAS） at 2,10 min after blocking and the muscle strength of the shoulder joint,elbow joint,wrist joint was observed after surgery.Results： Compared with the BP group,the clinical effect of ultrasound-guide upper trunk blocking was much better （P〈0.001）,even though consume less local anaesthetic.The muscular motor block degrees of the shoulder and elbow joint were Similar in two groups,but ultrasound-guide upper trunk block had a less wrist joint block.Conclusion： The technique of ultrasound-guide upper trunk block can be performed during the operations of shoulder joint and upper arm with satisfactory anesthesia.It performs the procedure of precision anesthesia by means of decreasing the amount of local anesthetic,improving the quality of anesthesia,reducing the block degree of the distal joint and which is beneficial to the rehabilitation of patients.