超声引导下行臂丛神经阻滞在上肢手术中的应用

目的:探讨超声引导臂丛神经阻滞在上肢手术中的应用效果。方法:选择择期上肢手术患者160例,随机分为4组:传统方法组(A组)、神经刺激器组(B组)、彩色超声引导组(C组)、彩色超声引导神经刺激器组(D组),局麻药为0.375%罗哌卡因30 ml。记录正中神经、尺神经、桡神经、肌皮神经阻滞起效时间;评价麻醉效果(优、良、差),记录并发症。结果:A组神经阻滞起效时间明显长于其他3组,而且C、D组明显短于B组(P<0.01),C、D组差异无统计学意义(P>0.05)。麻醉优等率C、D组明显高于A、B组(P<0.05),C、D组差异无统计学意义(P>0.05)。D组中神经刺激器是否引出上肢肌群收缩不影响麻醉效果(P>0.05)。A组中有4例并发症,B组中有2例并发症,但均未出现严重并发症。结论:与传统方法和神经刺激器方法相比,彩色超声引导臂丛神经阻滞方法麻醉起效快,麻醉效果好,提高了麻醉安全性和有效性,同时在使用彩色超声时神经刺激器的辅助作用有限。

Application of ultrasound-guided brachial plexus block in upper limb surgery

Objective：To discuss the outcome of application of ultrasound-guided brachial plexus block in upper limb surgery. Methods： 160 selected patients who would receive upper limb surgeries were assigned into four groups randomly. Group A was given traditional method. Group B was neurostimulator. Group C was by ultrasound guidance. Group D was ultrasound-guided neurostimulator. Local anesthetic was given with 0. 375% ropivaca in 30 ml. The complications were recorded. Results： The time of block effect in group A was significantly longer than the other groups and the time in group C and D was significantly shorter than group B（P0.01）. Whether neurostimulator induced contraction of upper limb muscle did not affect anesthetic effect（P0.05）. 4 patients in group A and 2 patients in group B experienced complications. There were no severe complications in all groups. Conclusion： Ultrasound-guided brachial plexus block took effect more quickly than neurostimulator and had better outcome,improved the safety and effectiveness of anesthesia. Neurostimulator played a limited role when ultrasound was used.