醉酒后患者臂丛神经阻滞的临床观察分析

Clinical observation and analysis on brachial plexus block in drunk patients

目的观察急性酒精中毒患者与未饮酒患者在行臂丛神经阻滞后阻滞效果和并发症发生率。方法30例醉酒后手、上肢受伤的急诊患者为醉酒组,30例未饮酒手、上肢受伤的急诊患者为对照组。年龄为18~60岁,体质量为50~80 kg,美国麻醉医师协会(ASA)分级为Ⅰ~Ⅱ级患者,在B超下行臂丛神经阻滞,选择肌间沟入路,局麻药配方为2%盐酸利多卡因10 ml+1%盐酸罗哌卡因10 ml,总共20 ml,反复回抽无回血后,注射局麻药。记录感觉消失起效时间,运动障碍起效时间,运动障碍维持时间,并发症。结果2组患者麻醉起效时间、维持时间的比较差异无统计学意义(P>0.05);但醉酒组并发症发生率17%,局麻药中毒3例,2例患者血压下降,心率升高;对照组未发生并发症。结论急性酒精中毒的患者与在行臂丛神经阻滞后,麻醉并发症高,尤其局麻药中毒反应,应引起重视,提高麻醉手术的安全。

Objective To investigate the outcome and complications of brachial plexus block in patients with acute alcoholism vs in non-drinking patients.Methods Included in this study were emergency cases of hand and upper limb injuries in drunk patients(drunk group,n=30)and in non-drinking patients(control group,n=30).All patients,aged 18-60 years,weighting 50-80 kg and with ASA gradesⅠ-Ⅱ,underwent B-ultrasound guided brachial plexus block via intermuscular groove.The local anesthetic formula consisting of 2%lidocaine hydrochloride 10 ml+1%ropivacaine hydrochloride 10 ml(20 ml in total),was injected after repeated withdrawal to ensure that no blood return occurred.The time to effective sensory block,time to effective motor block,the maintenance time of motor block,and complications were recorded.Results There were no significant differences in the time to onset of anesthetic effects and maintenance time between the two groups(P>0.05).However,complications occurred in 17%of the patients in the drunk group,with three cases of local anesthetics toxicity,two of lowered blood pressures and tachycardia,compared with no complications in the control group.Conclusion Patients with acute alcoholism and/or brachial plexus block are prone to higher risk of anesthetic complications,especially the local anesthetics toxicity.This observation warrants attention to ensure the safety of anesthesia for surgery.