超声联合神经刺激仪引导两种臂丛神经阻滞定位方法的比较

发布时间：2018-07-10 12:55

本文选题：臂丛神经阻滞 + 喙突　；参考：《临床麻醉学杂志》2015年07期

【摘要】：目的比较超声联合神经刺激仪引导喙突入路与锁骨中点下入路在锁骨下臂丛神经阻滞的临床效果。方法拟行前臂及手外科择期手术患者72例,随机均分为两组,每组36例,分别行超声联合神经刺激仪引导喙突入路(A组)或锁骨中点下入路(B组)锁骨下臂丛神经阻滞。将远端运动反应(手腕或手指屈曲或伸展)作为目标运动反应。记录患者前臂痛觉阻滞情况、穿刺成功率、试穿次数、上肢运动阻滞情况以及并发症。结果 A组有3例因5次调整穿刺针位置均未引出目标运动反应,改为腋路阻滞,被排除出本研究。与A组比较,B组1次、2次穿刺成功率明显增加,进针深度明显加深,环指状包绕腋动脉明显增多,腋路追加局麻药明显减少,所有肌皮神经阻滞明显增多(P0.05)。两组上肢运动阻滞差异无统计学意义。所有患者无一例气胸、穿刺部位血肿、局麻药中毒等。结论喙突入路或锁骨中点下入路锁骨下臂丛神经阻滞均可安全地用于区域阻滞,而锁骨中点下入路更容易定位到目标神经,麻醉阻滞效果更好。
[Abstract]:Objective to compare the clinical effects of ultrasound combined with nerve stimulator guiding coracoid approach and subclavian approach in subclavian brachial plexus block. Methods Seventy-two patients with selective operation of forearm and hand surgery were randomly divided into two groups, 36 cases in each group. They were treated with ultrasound combined with nerve stimulator guided coracoid protruding approach (group A) or subclavian subpoint approach (group B) with subclavian brachial plexus block. The distal movement response (wrist or finger flexion or extension) is used as the target motion response. The pain block of forearm, the success rate of puncture, the number of times of puncture, the condition of upper limb motor block and complications were recorded. Results in group A, 3 cases of axillary block were excluded from this study because of 5 times adjusting the position of puncture needle. Compared with group A, the success rate of one and two times puncture in group B was significantly increased, the depth of needle was significantly deepened, the number of circumferential fingers around the axillary artery was obviously increased, the number of additional local anesthetics in axillary approach was obviously decreased, and the number of all musculocutaneous nerve block was obviously increased (P0.05). There was no significant difference in upper limb motor block between the two groups. None of the patients had pneumothorax, hematoma at puncture site, local anesthetic poisoning and so on. Conclusion Coracoid process or subclavicular brachial plexus block can be safely used in regional block, and subclavicular approach is easier to locate the target nerve, and the anesthetic effect is better.
【作者单位】：四川省医学科学院四川省人民医院麻醉科;
【分类号】：R614

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