超声引导下肌间沟入路臂丛神经阻滞麻醉效果观察

Clinical observation on anesthetic effect of ultrasound-guided interscalene brachial plexus block

目的观察超声引导下肌间沟入路臂丛神经阻滞的麻醉效果。方法选择2014年5月至2016年3月期间ASAΙ~Ⅱ级、体格正常、18~55岁男性,拟行单侧上肢手部手术患者100例。在超声引导下行肌间沟臂丛神经阻滞,观察记录注药前的超声解剖图像、注药前臂丛神经上、中、下干下缘到皮肤的距离;观察记录操作用时、麻醉阻滞效果及不良反应发生率。结果各神经干下缘到皮肤的距离(平均值):上干1.002 cm(100例),中干1.598 cm(100例),下干2.26 cm(45例)。操作平均用时为3 min 56 s;92%的操作用时在3~5 min内。麻醉效果中优81%,良11%,差6%,无效2%,有效率为92%;不良反应有霍纳征3例、注药后寒颤1例、术中恶心、呕吐1例。结论超声引导下肌间沟入路臂丛神经阻滞适用于单侧上肢手部桡侧手术,对于涉及到上肢手部尺侧的手术,在安全范围内,应用较大剂量(浓度)的局麻药和(或)追加尺神经阻滞是有必要的。

Objective To observe anesthetic effect of ultrasound-guided interscalene brachial plexus block.Methods One hundred male ASA classⅠ or Ⅱ patients with aged 18~55 years old undergoing upper limb operation in our hospital during May 2014 to March 2016 March. Ultrasound guided interscalene brachial plexus block was performed for all the patients. The ultrasound anatomical image before and after the injection and the neural stem distance(superior, middle and interior) to the skin were observed. The operating time, the effect of anesthesia, the incidence of adverse reactions were recorded. Results Each lower edge of neural stem distance to the skin(average): superior was1.002 cm(n=100), middle was 1.598 cm(n=100), interior was 2.26 cm(n=45); Average operating time was 3 minutes and 56 seconds, with 92%(92/100) within 3 to 5 minutes. Anesthetic effect: excellent 81%(81/100), good 11%(11/100),poor 6%(6/100), invalid 2%(2/100), effective rate 92%. Adverse reaction statistics: three cases of Horner syndrome,one case of chills after injection, one case of intraoperative nausea and vomiting. Conclusion Local ultrasound-guided interscalene brachial plexus block approach provides excellent block with fewer adverse reactions in the radial side of upper limb surgery. In the upper extremity ulnar surgery, using a larger dose of local anesthetic and(or) extra local anesthesia and the ulnar nerve lock are necessary in the context of security.