超声引导下远端周围神经阻滞对急诊手外伤患者术后康复的影响

Effect of ultrasound-guided distal peripheral nerve block on postoperative rehabilitation in patients with emergency hand trauma

目的探讨超声引导下远端周围神经阻滞(DPNB)和腋路臂丛神经阻滞(ABPB)对急诊手外伤患者上肢运动功能和术后快速康复的影响。方法选择急诊手外伤患者92例,男71例,女21例,年龄18~79岁,ASAⅠ或Ⅱ级。采用随机数字表法将患者随机分为两组:DPNB组(D组)和ABPB组(A组),每组46例。两组分别于超声引导下行DPNB和ABPB,均给予0.5%罗哌卡因和1%利多卡因混合液。记录阻滞操作时间、阻滞起效时间、局麻药用量、术中追加镇痛药例数、阻滞效果分级情况。记录术中肘关节、腕关节及手指的运动阻滞情况。记录入院时、术后6 h、出院时Barthel指数。记录住院时间以及局麻药中毒、神经损伤、血管穿刺和气胸等并发症的发生情况。结果与A组比较,D组阻滞操作时间和阻滞起效时间明显缩短,局麻药用量明显减少,肘关节、腕关节及手指运动阻滞发生率明显降低,住院时间明显缩短,术后6 h Barthel指数明显升高(P<0.05)。两组术中追加镇痛药及阻滞效果分级差异无统计学意义。两组均未发生局麻药中毒、神经损伤、血管穿刺和气胸等并发症。结论在急诊手外伤手术患者中,超声引导下远端周围神经阻滞较腋路臂丛神经阻滞更好地保留了上肢运动功能,且更有利于患者术后快速康复。

Objective To investigate the effects of ultrasound-guided distal peripheral nerve block(DPNB)and axillary brachial plexus block(ABPB)on upper limb motor function and rapid postoperative recovery in patients with emergency hand trauma.Methods Ninety-two patients with emergency hand trauma,71 males and 21 females,aged 18-79 years,ASA physical statusⅠorⅡ,were randomly divided into two groups:DPNB group(group D)and ABPB group(group A),46 patients in each group.The two groups received ultrasound-guided DPNB and ABPB,respectively,and were given a mixture of 0.5%ropivacaine and 1%lidocaine.The block operation time,block onset time,local anesthetic dosage,additional analgesia during operation,and the grade of block effect were recorded.The intraoperative motor block of elbow,wrist,and finger was recorded.The Barthel index at admission,6 hours after surgery,and at discharge was recorded.The hospital stay and occurrence of complications such as local anesthetic poisoning,nerve injury,vascular puncture,and pneumothorax were also recorded.Results Compared with group A,the block performance time,block onset time,local anesthetic dosage,the incidence of motor block in elbow,wrist,and fingers,and the hospital stay were significantly lower,whereas the Barthel index 6 hours after operation was significantly higher in group D(P<0.05).There was no significant difference between the two groups in additional analgesia during operation and in the grade of block effect.No such complications occurred as local anesthetic poisoning,nerve injury,vascular puncture and pneumothorax occurred in the two groups.Conclusion In patients with emergent hand trauma,distal peripheral nerve block can better preserve upper limb motor function than axillary brachial plexus block,and it is more beneficial to the rapid recovery of patients after operation.