摘要
目的了解锁骨下臂丛神经阻滞中,神经刺激器定位时所用的最小刺激电流与阻滞效果之间的关系。方法选择188例择期行上肢肘以下外科手术的患者。分成较小电流组(A 组,n=118例)和大电流组(B 组,n=70例)。采用 Wilson 提出的喙突入路,通过神经刺激器定位。分别将两组病例的最小刺激电流(I)调整至0.1 mA≤<0.3 mA 或0.3 mA≤<0.5 mA,在能够引发远端运动反应的情况下给0.5%罗哌卡因30 ml。给药后5 min、10 min、20 min、30 min 分别记录麻醉阻滞区域。以给药后30 min,上肢的5支终末神经(正中神经,肌皮神经,桡神经,尺神经,前臂内侧皮神经)分布的皮区痛觉完全消失定义为阻滞成功。结果 A 组阻滞成功率为84.7%,B 组阻滞成功率为67.1%,A 组成功率显著高于 B 组(P<0.05)。对分层后亚组的分析显示,在引发后束运动反应的病例(n=124例)中,A 组病例(n=86例)的阻滞成功率为96.5%,B 组病例(n=38例)的阻滞成功率为78.9%,A 组成功率明显高于 B 组(P<0.05)。结论减小最小刺激电流至0.3 mA 以下可以明显提高锁骨下臂丛神经阻滞的成功率,尤其在引发后束所支配的运动反应时,可以获得极高的阻滞成功率(96.5%)。
Objective To investigate if low minimal stimulating current used in nerve stimulator localizing is associated with a greater likelihood of infraclavicular block success. Methods 188 patients, aged 14 to 64, of ASA physical status class Ⅰ - Ⅱ, and scheduled for surgical procedures below elbow were assigned to low current group （ Group A, n = 118） or regular current group （ Group B, n =70） according to the last figure of admission number. The infraclavicular plexus block was performed using the Wilson＇s approach 2 cm medial and caudal to the coracoid process guided by nerve stimulator with 30 ml of 0.5% ropivacaine after eliciting distal motor responses. The minimal stimulating current （I） was adjusted to 0.1 mA ≤ I 〈 0.3 mA in Group A or 0.3 mA ≤ I 〈 0.5 mA in Group B. The 2 groups were further sub-divided into 2 subgroups： lateral cord subgroup when motor responses of wrist and finger-flexion and pronation of forearm were induced, and posterior subgroup when extension of wrist and finger was induced. Anesthesia efficacy was assessed 5, 10, 20 and 30 min after the local anesthetic injection. A successful blockade was defined as analgesia in all dermatomes of the five nerves （ median nerve, musculocutaneous nerve, radial nerve, ulnar nerve, and medial antebrachial cutaneous nerve）. Results The success rate of Group A was 84.7%, significantly higher than that of Group B （ 67.1% , P 〈 0.05 ）. When divided into posterior and lateral cord subgroups, The success rate of the posterior subgroup of Group A was 96.5%, significantly higher than that of the posterior subgroup of Group B （ 78. 9%, P 〈 0. 05 ） Conclusion Minimal stimulating current lower than 0. 3 mA, significantly lower than the recommended value （ 0. 5 mA ）, improves the efficacy of infraclavicular brachial plexus block, especially when the posterior cord is stimulated.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第21期1470-1473,共4页
National Medical Journal of China
关键词
麻醉
局部
臂丛
阻滞
最小刺激电流
Anesthesia, local
Brachial plexus
Block
Minimal stimulating current
