超声联合神经刺激仪臂丛神经干精准阻滞在肥胖患者上肢手术中的应用

目的 观察超声联合神经刺激仪臂丛神经干精准阻滞用于肥胖患者上肢手术中的麻醉效果。方法 选择2017年10月~2018年10月安徽医科大学附属巢湖医院收治的100例上肢手术肥胖患者为研究对象。根据随机数字表法分为超声联合神经刺激仪组（US-NS组）和超声组（US组）,每组50例。US组采用超声引导下肌间沟臂丛神经阻滞,US-NS组采用超声联合神经刺激仪肌间沟臂丛神经阻滞。比较两组麻醉操作时间（T1）、阻滞完全时间（T2）、麻醉持续时间（T3）、麻醉效果分级、阻滞成功率及并发症发生率。结果 US-NS组阻滞成功率高于US组（98.00% vs 86.00%）,差异有统计学意义（P＜0.05）;US-NS组T2短于US组[（7.70±1.54）min vs （10.30±1.39）min],差异有统计学意义（P＜0.05）;US-NS组T3长于US组[（7.95±2.89）h vs（9.69±2.34）h],差异有统计学意义（P＜0.05）;US-NS组T1长于US组[（7.43±1.36）min vs（5.30±1.44）min],差异有统计学意义（P＜0.05）。结论 超声联合神经刺激仪用于肥胖患者臂丛神经阻滞成功率高,起效快。     

超声引导技术在肌间沟臂丛神经两点阻滞中的应用

目的比较超声引导定位法与神经刺激器引导定位法用于肌间沟臂丛神经阻滞的效果。方法拟行上肢手术的患者90例随机分为3组(n=30),对照组:神经刺激器定位单点阻滞组;US组:超声引导与神经刺激器确认相结合定位单点阻滞组;UD组:超声引导与神经刺激器确认相结合定位两点阻滞组。各组均给予0.5%的罗哌卡因30 mL,其中UD组被阻滞的两支目标神经各给予15 mL。结果UD组阻滞平均起效的时间明显短于US组和对照组。UD组感觉神经阻滞完善率明显高于US组和对照组。结论超声引导下行肌间沟臂丛神经阻滞起效快,并发症少;超声引导下两点阻滞法可明显改善阻滞效果。     

超声引导下锁骨下喙突旁与肌间沟臂丛神经阻滞的效果对比

目的对比研究超声引导下锁骨下喙突旁与肌间沟臂丛神经阻滞的效果。方法选取行手臂或者手部手术患者62例,随机分肌间组(32例)和喙突组(30例),肌间组采取肌间沟臂丛神经阻滞,喙突组采取锁骨下喙突旁臂丛神经阻滞,比较两组应用效果。结果喙突组臂内侧皮神经、前臂内侧皮神经、尺神经起效时间短于肌间组,差异有统计学意义(P0.05)。喙突组臂内侧皮神经、前臂内侧皮神经、尺神经的显效率均高于肌间组,差异有统计学意义(P0.05)。结论超声引导下锁骨下喙突旁阻滞的效果优于肌间沟入路臂丛神经阻滞,是更加优秀的麻醉方法。     

超声引导技术在肌间沟臂丛神经阻滞麻醉中的应用

目的探讨超声引导技术在臂丛神经阻滞麻醉中的临床应用。方法将2012年3月~2012年8月,60例行择期上肢手术的患者,随机分成A、B两组各30例。A组选择在超声引导下行肌间沟臂丛神经阻滞,B组选择传统异感定位肌间沟臂丛阻滞法。所用局麻药为0.45%罗哌卡因40ml。观察并比较两组患者的麻醉起效时间、阻滞完善率、麻醉效果、并发症及术中舒适度。结果 A组仅有2例刺破血管,B组有8例刺破血管、1例局麻药中毒、2例术后感觉异常。结论超声引导下肌间沟臂丛神经阻滞麻醉具有操作时间短、阻滞效果完善、并发症发生率少等特点,有临床推广应用的价值。     

锁骨下臂丛阻滞两种不同入路的比较研究

目的:通过解剖学以及超声影像学方法比较两种锁骨下臂丛神经阻滞最常用的入路-喙突入路与VIP入路的进针点准确性以及安全性.方法:实验分两部分,(1)应用解剖学方法分析喙突人路与VIP入路的体表进针点与臂从神经的相互关系、进针深度以及进针点与肋骨或肋间肌的关系.(2)应用超声影像学方法分析两种入路体表进针点与腋动脉前壁的相互关系、进针点皮肤至腋动脉前壁的距离以及腋动脉前壁与胸膜的关系.结果:(1)喙突入路中,进针点与喙突尖的垂直距离小于总体均数2(P＜0.05);VIP入路中进针点与臂丛神经的距离与总体均数0比较,差异无统计学意义;VIP入路的臂丛神经深度以及进针点与胸廓的距离分别小于喙突入路(P＜0.05).(2)喙突入路中,探头中心与喙突尖的水平以及垂直距离与总体均数2比较差异无统计学意义;VIP入路中,探头中心与进针点的距离与总体均数0比较差异无统计学意义;VIP入路中的腋动脉前壁深度以及腋动脉前壁与胸膜的距离分别小于喙突入路(P＜0.05).结论:两种入路相比,喙突入路较VIP入路更具有安全优势.喙突入路中2 cm的值可能偏大,需要根据患者的体型调整进针点与喙突尖的水平及垂直距离.     

角袋注射技术对锁骨上臂丛神经阻滞后膈肌麻痹的影响

目的 分析角袋注射技术的临床疗效及对锁骨上臂丛神经阻滞后膈肌麻痹的影响。方法 选择2020年1月至2021年12月于沧州市人民医院诊治的需在臂丛神经阻滞麻醉下行手术患者80例,其中男性52例,女性28例;年龄20～40岁,平均年龄30.46岁;身体质量指数(BMI)17.42～28.01 kg/m²,平均BMI 22.51 kg/m²;美国麻醉医师协会(ASA)分级Ⅰ级24例,Ⅱ级40例,Ⅲ级16例;手术部位,肘部24例,前臂21例,手腕27例,手8例。随机分为试验组(n=40例)及对照组(n=40例)。对照组予传统神经丛周围阻滞麻醉,试验组则采用超声引导角袋注射技术进行麻醉。对两组患者麻醉前和麻醉后30 min平静呼吸膈肌移动度及肺功能指标进行比较。比较两组患者膈肌麻痹发生率及并发症;以患者阻滞后30 min是否出现膈肌麻痹为终点,对两组患者阻滞后30 min用力呼吸膈肌移动度与膈肌麻痹发生风险进行比较。结果试验组麻醉效果为优良率的患者明显高于对照组[92.5%(37/40) vs 70%(28/40)。P <0.05]。感觉及运动阻...     

腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术

目的　探讨腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术的可行性。 方法　60例患者随机均分为3组,A组：腋窝顶定位穿刺锁骨下位点阻滞麻醉;B组：插管全麻;C组：腋窝顶定位穿刺锁骨下位点阻滞复合插管全麻,术后用PCIA泵镇痛和VAS评价镇痛程度。评估术中除共同项目外,麻醉技术、耗材和药品所产生的医疗费用。 结果　3组患者一般情况比较差异无统计学意义（P>0.05）;术中全麻丙泊酚和瑞芬太尼每小时应用剂量、术后唤醒和拔管定向力恢复时间,B组显著多或长于C组（P<0.01）;麻醉前准备、操作完成时间A组相似文献   

锁骨中点内上方阻滞臂丛神经的解剖学

目的:为临床麻醉工作者提供锁骨中点上方阻滞人路方法.方法:在经10％甲醛溶液固定的60侧头颈、上肢标本及锁骨中点矢状切断面标本上测量臂丛的长度、第1肋上面臂丛神经3束汇合处的直径,确定臂丛阻滞进针点、进针方向、进针角度、进针深度、确定锁骨下动脉的保护角度.结果:臂丛神经的长度为108.09mm±12.49 mm;第1肋...     

超声引导下连续肌间沟臂丛神经阻滞在肥胖患者上肢手术的应用

目的探讨超声引导下肌间沟臂丛神经阻滞在肥胖患者上肢手术中的应用。方法选取60例上肢手术肥胖患者随机分为观察组(n=30)行超声引导定位,对照组(n=30)行体表标志定位。结果观察组穿刺成功率为96.67%,麻醉操作、阻滞起效时间短麻醉优良率较高(P0.05)。结论超声引导下肌间沟臂丛神经阻滞可缩短操作时间,提高麻醉效果,值得推广。     

针麻仪神经刺激与异感定位法对肌间沟臂丛一点阻滞效果的比较

目的比较异感定位或神经刺激定位对肌间沟臂丛一点阻滞效的起效时间、成功率以及并发症。方法以神经刺激定位法（PNS）或诱发异感法（PAR）定位臂丛神经主支,注入1.5%利多卡因和0.25%布比卡因合剂20ml,观察和记录阻滞操作时间,阻滞起效时间,可行手术时间及总的麻醉时间。结果PNS组各项时间均明显短于PAR组、PNS组的完全阻滞发生率较PAR组高（P〈0.05）。结论PNS较PAR成功率更高,阻滞出现更快,麻醉效果好,技术优势显著,值得推广。     

超声联合神经刺激仪引导腰骶丛神经阻滞在 老年髋部手术中的应用

目的 探讨超声联合神经刺激仪引导腰骶丛神经阻滞在老年髋部手术中的应用效果。方法 选择2017年5月~2018年9月于我院接受髋部手术的老年患者76例,采用随机数字表法分为研究组与对照组,每组38例。两组患者均行腰骶丛神经阻滞,研究组采用超声联合神经刺激仪引导,对照组仅采用神经刺激仪定位,比较两组的阻滞完成时间、麻醉起效时间、下床活动时间、出院时间、麻醉维持时间和术后VAS疼痛评分。结果 研究组阻滞完成时间、麻醉起效时间、下床活动时间、出院时间分别为（12.08±2.14）min、（7.75±1.02）min、（4.27±1.09）d、（5.82±2.10）d,分别短于对照组的（17.85±3.94）min、（10.21±1.19）min、（6.05±1.47）d、（7.33±1.65）d,研究组麻醉维持时间为（781.78±30.14）min,长于对照组的（713.99±25.96）min,差异具有统计学意义（P＜0.05）。研究组患者术后2、4、8、24 h的VAS评分分别为（0.78±0.19）分、（0.85±0.24）分、（1.39±0.43）分、（1.66±0.65）分,分别低于对照组的（1.94±0.35）分、（3.27±0.71）分、（3.10±0.64）分、（3.07±0.78）分,差异具有统计学意义（P＜0.05）。结论 超声联合神经刺激仪引导腰骶丛神经阻滞在老年髋部手术中的应用准确度高,神经阻滞起效时间短,术后镇痛效果佳。     

Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery

Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient''s satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner''s syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient''s satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient''s satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.     

Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Techniques: Perineural Injection versus Single or Double Perivascular Infiltration

Purpose

We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique.

Materials and Methods

78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 µg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o''clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o''clock and 6-o''clock position. For all groups, musculocutaneous nerve was blocked separately.

Results

The PN group (391.2±171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8±59.0 sec) and PV2 (211.4±58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4±149.6 sec) than PV1 (557.6±194.9 sec) and PV2 (561.5±129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%).

Conclusion

The PV injection technique consisting of a single injection in 12-o''clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.     

超声引导下颈神经根阻滞治疗神经根型颈椎病的疗效

目的 探讨超声引导下颈神经根阻滞治疗神经根型颈椎病的临床疗效。方法 选择2017年1月~2018年9月我院收治的神经根型颈椎病患者56例,随机分为观察组和对照组,每组28例。对照组采用传统解剖定位法行颈椎旁神经根阻滞,观察组在超声引导下进行颈神经根阻滞治疗,比较两组阻滞前和阻滞后1周的视觉模拟评分（VAS）、阻滞后2周的临床疗效及不良反应发生率。结果 阻滞前两组VAS疼痛评分比较,差异无统计学意义（P＞0.05）;阻滞后1周,观察组VAS评分低于对照组［（1.46±1.15）分vs（3.12±0.76）分］,差异有统计学意义（P＜0.05）。观察组优良率为89.29%,高于对照组的64.29%,差异有统计学意义（P＜0.05）。观察组不良反应发生率为0,低于对照组的7.14%,但差异无统计学意义（P＞0.05）。结论 超声引导下颈神经根阻滞治疗神经根型颈椎病具有较好的临床疗效,安全性高。     

超声引导前路坐骨、股神经阻滞在腰椎疾病下肢手术的应用研究

目的 探讨超声引导下前路坐骨神经、股神经阻滞麻醉联合全身麻醉在腰椎疾病行下肢手术中的应用可行性。方法 选取2016年12月~2017年6月于我院行下肢手术的腰椎疾病患者80例,随机分为观察组和对照组,各40例,对照组患者行单纯全身麻醉,观察组在全身麻醉的同时联合B超引导前路坐骨神经、股神经阻滞。分析两组患者的术后苏醒时间、苏醒后躁动情况及麻醉药物的用量。结果 观察组患者手术中麻醉药物用量少于对照组,患者的拔管时间及苏醒时间也比对照组短,差异具有统计学意义（P＜0.05）。观察组患者苏醒后的躁动情况发生率及躁动程度均低于对照组,差异具有统计学意义（P＜0.05）。结论 超声引导下前路坐骨神经、股神经阻滞联合全身麻醉在腰椎疾病患者中,能够减少镇痛药物用量,维持稳定的术中血流,提高镇痛效果,促进拔管与早期活动,是理想的下肢骨折手术麻醉方式。     

The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study

Objective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery.Methods: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded.Results: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N.Conclusion: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.     

多种药物联合神经阻滞治疗疼痛休克患者的1例护理

总结1例多种药物联合神经阻滞治疗疼痛休克患者的护理经验,护理要点主要包括:休克患者的急救、正确合理服用羟考酮缓释片、心理护理、神经阻滞的护理。该患者住院期间配合治疗,住院28 d后疼痛明显减轻后住院。     

超声引导双侧胸椎旁神经阻滞用于开放性 胃癌根治术患者的镇痛效果观察

目的 观察超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治术患者的镇痛效果。方法 选择择期开放性胃癌根治手术患者50例,随机数字表法随机分为全麻组（G组）和全麻复合椎旁神经阻滞组（P组）,各25例。G组行气管插管静脉全麻,P组于全麻前行超声引导椎旁神经阻滞。记录基础值（T0）、手术前（T1）、手术5 min（T2）、手术探查时（T3）、手术20 min（T4）、手术1 h（T5）、手术结束（T6）各时间点的MAP和HR,患者术后2 h、4 h、8 h、12 h、24 h、48 h的静息和活动时的VAS评分,术中及术后镇痛药物用量,气管拔管时间,PACU停留时间,观察相关并发症的发生率。结果 与G组对比,P组术后4 h、8 h、12 h、24 h的静息及12 h内的活动时VAS评分降低,气管拔管时间缩短,术后躁动发生率降低,差异均具有统计学意义（P＜0.05）,术中舒芬太尼及术后追加镇痛药用量降低,T2、T3时间点的MAP及T2、T3、T4、T5时间点的HR较低,更为平稳。结论 超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治手术患者具有良好的镇痛作用。     

Anatomical Study of the Brachial Plexus in the Common Marmoset (Callithrix Jacchus)

To elucidate the forelimb phylogeny of primates, anatomical analysis of the brachial plexus in platyrrhines is beneficial. In the present study, six brachial plexuses and the surrounding arteries of four common marmosets were dissected. In five specimens, the brachial plexus consisted of five ventral rami from the fifth cervical nerve (C5) to the first thoracic nerve (T1). In one specimen, the ventral ramus of the fourth cervical nerve joined with the brachial plexus. In five specimens, the upper trunk was composed of C5 and the sixth cervical nerve (C6). In one specimen, the ventral division of C6 merged with the ventral branch of the middle trunk to constitute the lateral cord. The seventh cervical nerve constituted the middle trunk, and the eighth cervical nerve and T1 formed the lower trunk in all specimens. The lateral cord gave rise to the musculocutaneous nerve, and the remaining component merged with the medial cord. The confluence of the lateral and medial cords immediately bifurcated into the median and ulnar nerves. These branching patterns of the musculocutaneous, median, and ulnar nerves were consistent and similar to the human counterparts. In the dorsal division, the single posterior cord as observed in the human brachial plexus was not observed. The axillary artery did not pass between the medial and lateral roots of the median nerve, and the axillary artery bifurcated into the brachial artery and the superficial brachial artery. Anat Rec, 300:1299–1306, 2017. © 2017 Wiley Periodicals, Inc.