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肌电图观察超声引导锁骨上臂丛神经阻滞对膈神经传导和膈肌电位的影响
基金项目:军区医学科技创新课题项目(14MS006)
摘    要:
目的肌电图观察超声引导锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)对膈神经传导(phrenic nerve conduction,PNC)和膈肌电位的影响。方法选取90例择期行前臂骨折取内固定装置术患者,随机分为A组(0.375%罗哌卡因20 mL)、B组(0.5%罗哌卡因20 mL)和C组(0.75%罗哌卡因20 mL),每组各30例。所有患者均在超声引导下进行SCBPB,应用肌电图测量PNC数据,对阻滞前、阻滞后5、10、15、30 min的PNC潜伏期及膈肌复合肌肉动作电位(compound muscle action potential,CMAP)波幅测量三次记录平均值。测试阻滞后5、10、15、30 min阻滞情况,观察并记录三组的阻滞起效时间、镇痛效果、阻滞维持时间及术后24 h阻滞相关并发症。结果 A组阻滞后CMAP波幅小于阻滞前50%的概率高于B、C组,差异有统计学意义(P0.05)。A组比B、C组阻滞起效时间慢,阻滞维持时间短,差异有统计学意义(P0.05),三组在臂丛阻滞后PNC潜伏期均有不同程度的延长,30 min阻滞效果、术后24 h阻滞相关并发症无显著差异(P0.05)。结论 0.375%、0.5%和0.75%罗哌卡因20 mL在超声引导下行SCBPB在注药后30 min均可以达到满意的阻滞效果,0.375%罗哌卡因20 mL比0.5%、0.75%罗哌卡因20 mL行SCBPB对CMAP波幅影响小。

关 键 词:超声;膈神经传导;锁骨上;臂丛神经阻滞;罗哌卡因

Electromyographic observation of the effects of ultrasound-guided supraclavicular brachial plexus block on phrenic nerve conduction and diaphragmatic potential
Abstract:
Objective To observe the effects of ultrasound-guided supraclavicular brachial plexus block (SCBPB) on phrenic nerve conduction(PNC) and diaphragm muscle potential.Methods Ninety patients who underwent forearm fracture Internal fixation device removal surgery were randomly divided into group A(0.375% ropivacaine 20 mL),group B(0.5% ropivacaine 20 mL),and group C(0.75% ropivacaine 20 mL),with 30 cases in each group.All patients underwent SCBPB under ultrasound guidance,and applied electromyography to measure PNC data.The PNC latency and compound muscle action potential (CMAP) amplitude of the diaphragm muscle were measured three times and the average value was recorded before blocking and 5,10,15,30 minutes after blocking.The block situation was tested at 5,10,15,30 minutes after the block.The block onset time,analgesic effect,block maintenance time and block-related complications at 24 hours after surgery were observed and recorded.Results The probability of CMAP amplitude after block less than 50% before block in group A was higher than that in groups B and C,and the difference was statistically significant(P<0.05).Group A had a slower onset time and shorter block maintenance time than group B and group C,and the difference was statistically significant(P<0.05).All three groups have prolonged PNC latency after brachial plexus block.There were no significant differences in 30-minute block effect and 24-hour block-related complications(P>0.05).Conclusion 0.375%,0.5%,and 0.75% ropivacaine 20 mL under ultrasound guidance can achieve satisfactory block effect in SCBPB 30 minutes after injection.0.375% ropivacaine 20 mL for SCBPB has less effect on the CMAP amplitude compared with 0.5%,0.75% ropivacaine 20 mL.
Keywords:Ultrasound   Phrenic nerve conduction   Supraclavicular   Brachial plexus block   Ropivacaine
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