摘要
目的研究腋窝顶定位穿刺锁骨下位点阻滞麻醉的可行性。方法520例急诊成人上肢手术的患者随机均分为两组：腋窝顶定位穿刺锁骨下位点阻滞麻醉组（观察组）和腋窝内径路阻滞麻醉组（对照组），两组均采用0．375％罗哌卡因，容量（40．0±2．7）ml作为臂丛神经阻滞麻醉药物。比较组间穿刺注药完成后的30min内，感觉运动阻滞起效时间、感觉运动阻滞效果、各神经分支感觉阻滞效果及神经阻滞综合效果；比较组间穿刺注药完成30min后，2,4、6、8h四个时点的视觉模拟评分法（VAS）评分及止血带止痛时间。结果穿刺注药完成后的30min内，观察组感觉运动阻滞起效时间显著短于对照组，维持时间显著长于对照组（P〈0．01）；组间感觉运动阻滞评分及正中、尺神经阻滞效果差异无统计学意义，肌皮、桡神经阻滞效果显著好于对照组（P〈0．05）。穿刺注药完成30min后，VAS评分各时点组间比较观察组显著小于对照组（P〈0．01），止血带止痛时间组间比较观察组显著长于对照组（P〈0．01）。结论改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉，可提供上肢完善的阻滞技术，取得满意的麻醉效果，并具有较高的安全性。
Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla. Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla （experimental group） and block anesthesia with intraclavicular route （ control group）. Patients in both groups received 0.375% ropivacaine, volume （40.0 ±2.7）ml. During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded. The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes. Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer （ P 〈 0.01）. There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups. The musculecutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group （ P 〈 0.05）. After the dr-g had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the control group （ P 〈 0.01）. The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group （ P 〈 0.01 ）. Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.
出处
《中华手外科杂志》
CSCD
北大核心
2011年第2期105-109,共5页
Chinese Journal of Hand Surgery
基金
济南军区后勤科研基金资助项目（CJN09L068）
关键词
麻醉
臂丛
锁骨
神经肌肉阻滞
Anesthesia
Brachial plexus
Clavicle
Neuromuscular blockade
