斜引进针法在上肢手术肌间沟臂丛神经阻滞中的应用

The application of obliquitously puncturing in interscalene brachial plexus block for upper limbs surgery

目的分析斜引进针法应用于肌间沟臂丛神经阻滞的麻醉效果及安全性。方法择期行上肢手术的患者86例(ASAⅠ~Ⅱ级),随机分为A、B两组。A组采用斜引进针法,B组采用传统的垂直进针法。记录臂丛神经主要分支(腋神经、肌皮神经、桡神经、正中神经、尺神经)感觉阻滞及运动阻滞起效时间,并评价其阻滞完善率,评定麻醉效果,观察记录有无并发症。结果 A组患者臂丛神经主要分支感觉阻滞及运动阻滞起效时间明显短于B组(P<0.05),A组患者正中神经、尺神经的阻滞完善率明显高于B组(P<0.05),A组患者的麻醉效果明显优于B组(P<0.05),A组未见并发症,B组发生Horner综合征3例、局麻药中毒1例。结论斜引进针法应用于肌间沟臂丛神经阻滞麻醉起效快,效果确切,并发症少,值得临床推广和应用。

Objective To observe the validity and safety of obliquitously puncturing used in interscalene brachial plexus block for upper limbs surgery.Methods Eighty-six ASA class I or II patients scheduled for upper operation were randomized into two groups:group A and group B.Group A adopted obliquitously puncturing while group B adopted routine vertical needling.The feeling-block starting time,the motion-block starting time of the major branch(axillary nerve,musculocutaneous nerve,radial nerve,median nerve,ulnar nerve)in brachial plexus were recorded and the effective nerve block rate was evaluated.At the same time anesthetic effect and complications were also recorded.Results The feeling-block starting time,the motion-block starting time of the major branch in brachial plexus of group A were significantly shorter than that of group B(P<0.05).The effective nerve block rate of median nerve and ulnar nerve in group A was significantly higher than that in group B(P<0.05).The anesthetic effect in group A was superior to group B(P<0.05).There were no complications in group A,mean while three cases of horner symptom complex and one case of systemic local anesthetic toxication in group B.Conclusion The obliquitously puncture used in interscalene brachial plexus block offer shorter anesthetic onset time and favourable anesthetic effect.Any complications has not observed.So it is an innovative and convenient method to provide suitable surgery condition,worthy to be popularized clinically use.