改良锁骨下臂丛神经阻滞满意度的临床评价

目的 介绍一种改良的锁骨下臂丛神经阻滞方法，通过临床应用评价其效果与并发症。方法 选择86例ASAI～Ⅲ级，行前臂、手和腕部择期手术患者进行前瞻性研究。56例患者采用周围神经刺激定位仪(Stimuplex HNSll；B．Braun Melsungen AG，Melsungen)完成操作，其中20例置管。后30例患者采用找异感的方法，当患者有异感并放射到手的前臂或手指为针尖定位正确。结果 总的阻滞成功率95％(82例)。使用神经刺激仪定位单次给药的感觉阻滞效果最好，其次是置管患者，而传统定位的效果相对较差。肌皮神经、前臂正中神经阻、腋神经与前臂内侧皮神经滞效果最好。穿刺针平均深度7．2cm(5．5-9．0cm)。有20例留置导管，均通过周围神经刺激定位仪成功完成，置管深度(9．0&;#177;3．5)cm，超过针尖深度3cm，手术麻醉效果均满意阻滞成功率100％。手指有手术后感觉异常5l例，均在l周内完全消失。结论 此方法操作简单，体表标志可靠，可置管后固定，有效避免气胸的发生。     

超声引导下动态针尖定位法在桡动脉穿刺置管术中的应用效果

目的探讨超声引导下动态针尖定位法在桡动脉穿刺置管术中的应用效果。方法选取择期手术术中需行有创动脉血压监测的患者130例,按随机数字表法分为2组:研究组65例采用超声引导下动态针尖定位技术进行穿刺置管;对照组65例采用手指触摸定位法进行穿刺置管。比较2组穿刺成功率(首次穿刺成功率、5 min内穿刺总成功率)、穿刺耗时、穿刺过程疼痛评分以及不良反应情况。结果与对照组比较,研究组穿刺置管首次成功率、5 min内穿刺置管总成功率均显著升高,平均穿刺耗时显著缩短,疼痛VAS评分、不良反应(桡动脉血肿、痉挛)发生率均显著降低,差异均有统计学意义(均P<0.05)。结论超声引导下采用动态针尖定位法能够显著提高桡动脉穿刺置管的成功率,穿刺操作时间短,患者舒适度高,并发症少。     

肌间沟臂丛阻滞效果的CT评价

目的：应用CT观察局麻药在臂丛鞘内的分布与扩散状况,评价肌间沟臂丛阻滞的临床效果。方法：70例拟行上肢手术的患者,随机分为非异感组（NPAR组）、神经刺激组（PNS组）二组,每组35例,评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,每组随机10例行CT检查,扫描范围自C3至T3平面,并行注药侧的冠、矢状面CT重组,测量臂丛三干周围局麻药的扩散范围。结果：局麻药局限性分布于臂丛鞘内,肌间沟水平为完整的鞘样结构,其以下有明显的分隔,局麻药的分布范围在臂丛上干、中干两组间无明显差异,下干PNS组高于NPAR组（P<0.05）;二组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分差异均无统计学意义;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分NPAR组明显高于PNS组（P<0.05）。结论：臂丛鞘是一多腔结构,局麻药注射的位置和深度直接影响阻滞效果,偏向尺侧的手术采用PNS定位为佳。     

超声联合神经刺激仪定位引导臂丛神经阻滞麻醉的临床分析

<正>目前,上肢手术临床最常用的是臂丛神经阻滞麻醉,随着超声引导与麻醉学的融合,其阻滞成功率大大提高,并发症也不断减少。本组选取43例应用超声联合神经刺激仪定位引导臂丛神经阻滞麻醉的患者,观察麻醉效果,现报道如下。资料与方法一、临床资料选取2013年1月至2014年10月我院收治的上肢手术患者86例,将其随机分为联合组和B超组,每组各43例。联合组采用超声联合神经刺激定位仪进行治疗引导,其中男25例,女     

0.375%左旋布比卡因与罗哌卡因用于肌间沟臂丛神经阻滞的研究

目的:观察左旋布比卡因用于肌间沟臂丛神经阻滞的效果,同时比较左旋布比卡因与罗哌卡因在肌间沟臂丛神经阻滞中的麻醉效果。方法:选择行上肢手术的病人40例,随机分为两组,每组20例,分别用0.375%左旋布比卡因和罗哌卡因25mL行臂丛神经阻滞,记录各支神经感觉和运动阻滞开始时间,术后进行随访,并记录感觉阻滞恢复时间。结果:两组对腋神经、前臂外侧皮神经、桡神经和正中神经阻滞开始时间无明显差异(P>0.05),肋间臂和臂内侧皮神经、前臂内侧皮神经和尺神经阻滞开始时间左旋布比卡因组快于罗哌卡因组(P<0.05)。两组比较前臂和肘运动阻滞的开始时间差异无显著性(P>0.05),腕和手指运动阻滞的开始时间左旋布比卡因组快于罗哌卡因组(P<0.05),同时其感觉恢复时间也长于罗哌卡因组(P<0.01),两组术中阻滞满意度相同。结论:0.375%左旋布比卡因可用于肌间沟臂丛神经阻滞,桡侧感觉神经阻滞起效和罗哌卡因相同,但尺侧起效和运动神经阻滞起效快于罗哌卡因,同时感觉恢复时间也长于罗哌卡因,从而可提供满意的术后止痛。     

超声引导下肌间沟臂丛神经阻滞在肥胖患者中的临床效果

目的 比较超声引导下肌间沟臂丛神经阻滞和异感法肌间沟臂丛神经阻滞在肥胖患者中的临床效果.方法 将60例ASA Ⅰ-Ⅱ级的肥胖患者按随机数字表法分为异感组和超声定位组,每组30例;分别记录2组患者感觉阻滞起效时间、感觉完全阻滞情况、以及麻醉效果和并发症.结果 超声定位组正中神经和尺神经阻滞起效时间明显少于异感组(P＜0.01),超声定位组桡神经、正中神经和尺神经完全阻滞情况也明显优于异感组(P＜0.01),麻醉效果超声定位组优于异感组(P＜0.01).结论 超声定位下肌间沟臂丛神经阻滞对于肥胖患者起效快、成功率高、并发症少.     

超声引导下平面内联合平面外动态针尖定位技术在桡动脉穿刺置管中的应用效果

目的 评价超声引导下平面内联合平面外动态针尖定位技术在桡动脉穿刺置管中的应用效果.方法 将120例择期手术患者随机分为试验组与对照组,每组60例.试验组采用超声引导下平面内联合平面外动态针尖定位技术穿刺法,对照组采用传统触摸动脉搏动定位盲探穿刺法.比较2组患者桡动脉直径、穿刺置管首次成功率与5 min内总体成功率、穿刺...     

神经刺激仪定位下臂丛神经阻滞效果观察

目的探讨神经刺激仪引导下定位行臂丛神经阻滞的临床效果。方法将68例拟在臂丛神经阻滞下行择期手术的患者按随机数字表法分为2组,每组34例。Ⅰ组应用周围神经刺激仪行腋路、肌间沟联合臂丛神经阻滞：Ⅱ组运用传统方法行联合臂丛神经阻滞。阻滞后30min观察感觉和运动阻滞效果,对2组患者臂丛神经阻滞实施时间、阻滞起效时间、手术时间及术后并发症进行比较。结果2组手术时间比较差异无统计学意义（P〉0．05）。Ⅰ组阻滞时间及阻滞起效时间分别为（10．1±2．8）min和（12．9±1．8）min,Ⅱ组阻滞时间及阻滞起效时间分别为（11．5±2．7）min和（14．6±2．2）min,I组臂丛神经阻滞实施时间及阻滞起效时间较Ⅱ组明显缩短（均P〈0．05）。2组均未出现动脉损伤、气胸等并发症。结论神经刺激仪定位下臂丛神经阻滞较传统方法联合臂丛神经阻滞成功率更高．阻滞实施更快。     

两种治疗方法对腰椎间盘突出症治疗效果比较

目的 比较超声定位下选择性神经根阻滞治疗与神经刺激仪引导下神经阻滞治疗对腰椎间盘突出症(LD H)的治疗效果.方法 选取2019年1月至2020年2月铜川市人民医院收治的80例LD H患者作为研究对象,按照随机数字表法分为超声组和神经刺激仪组,每组各40例.超声组采取超声定位下选择性神经根阻滞治疗,神经刺激仪组采取神经刺激仪引导下神经阻滞治疗,比较两组患者镇痛效果、腰椎功能恢复、一次性穿刺成功率及治疗效果.结果 超声组和神经刺激仪组患者治疗1、3、6个月后视觉模拟评分(V A S评分)均较治疗前降低,差异均有统计学意义(P<0.05),但治疗前后两组患者组间VAS评分比较,差异无统计学意义(P>0.05);两组患者治疗1、3、6个月后Oswestry残障指数(ODI)评分均较治疗前降低,神经刺激仪组患者治疗后各时间点ODI评分均低于超声组,差异均有统计学意义(P<0.05);超声组患者一次性穿刺成功率(95.00％)高于神经刺激仪组(77.50％),差异有统计学意义(P<0.05);超声组患者治疗总有效率(97.50％)与神经刺激仪组(95.00％)比较,差异无统计学意义(P>0.05).结论 对LDH患者采取超声定位下选择性神经根阻滞与神经刺激仪引导下神经阻滞治疗,均可取得良好的镇痛与治疗效果,但神经刺激仪引导下神经阻滞治疗对腰椎功能改善效果更佳,而超声定位下选择性神经根阻滞治疗的一次性穿刺成功率更高.     

超声联合神经刺激引导逆行锁骨下与锁骨上臂丛阻滞的比较

目的:使用超声引导联合神经刺激仪,对逆行锁骨下和锁骨上臂丛神经阻滞的麻醉效果进行比较.方法:60例上肢手术患者随机分为逆行锁骨下入路臂丛神经阻滞(RI组)和锁骨下入路(S组)两组,使用超声定位及神经刺激确认目标神经.观察穿刺疼痛评分,注药后30 min内每5 min观察并记录臂丛神经感觉阻滞完善时间、不良反应与并发症.结果:RI组感觉神经阻滞成功率优于S组(P＜0.05),肌皮、正中神经阻滞完善比S组快(P＜0.05).RI组不良反应与并发症明显少于S组(P＜0.01).结论:逆行锁骨下臂丛神经阻滞的感觉神经阻滞效果优于锁骨上入路,起效较快,不良反应和并发症较少.     

超声引导下与神经刺激器联合超声引导下腋路臂丛神经阻滞在下肘部位手术患者麻醉中应用比较

[目的]比较神经刺激器联合超声引导及单纯超声引导行腋路臂丛神经阻滞在下肘部位手术患者麻醉中的应用效果.[方法]60例下肘部手术患者,随机分为观察组和对照组,各30例.对照组给予超声引导下腋路臂丛神经阻滞方案,观察组则予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案.比较两组受试者操作时间、相关神经阻滞的起效时间、神经阻滞持续时间及0.5 h内阻滞成功率、一次性穿刺成功率差异及相关并发症发生情况.[结果]观察组0.5 h内臂丛神经阻滞总成功率显著高于对照组(100.0%vs 86.7%),相关并发症发生率则显著低于对照组(6.7%vs 26.7%),且差异均有显著性(P均<0.05).观察组平均操作时间及桡神经、尺神经、正中神经、肌皮神经等阻滞起效时间均显著低于对照组,神经阻滞持续时间则明显长于对照组(P均<0.05);两组一次性穿刺成功率比较差异无显著性(P>0.05).[结论]对下肘部位手术患者予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案,利于提高其定位准确性及臂丛神经阻滞成功率,对降低其手术相关并发症发生风险、延长其神经阻滞持续时间等具有积极影响.     

The use of train of four monitoring for clinical evaluation of the axillary brachial plexus block

The axillary approach of brachial plexus anesthesia is the most commonly used technique for forearm and hand surgery. Dynamometer is known as objective test for the clinical assessment of motor block of the nerves in brachial plexus block. However, the use of this device may not always be practical in operating room. The train-of-four (TOF) test is a non-invasive peripheral nerve stimulator that shows the level of motor block of muscle relaxants. The aim of the study is to investigate the use of TOF testing as a peripheral nerve stimulator for objective clinical evaluation of motor block at axillary brachial plexus block. 44 patients were randomized according to the development of partial or complete motor in the axillary brachial plexus block. The nerves were selectively localized by nerve stimulation and ultrasound guidance. After obtaining an appropriate peripheral motor response, predetermined volumes of bupivacaine were selectively injected to the 4 nerves. Sensory, motor block levels and TOF values were measured at 10th, 20th, 30th minutes immediately after the axillary brachial plexus block. TOF values were gradually decreased and significant difference was observed between the development of a complete and partial motor block at 30th minute. TOF values were also significantly less in patients of complete sensory block than the patients of partial sensory block at 30th minute. The use of TOF monitoring may be beneficial to assess the objective clinical effect of motor block in the patients with axillary brachial plexus nerve block.     

心理干预对神经刺激器引导连续神经阻滞操作的影响

目的探讨心理干预对神经刺激器引导连续神经阻滞操作的影响。方法将48例需在神经刺激器引导下行经腋路臂丛连续神经阻滞患者按随机数字表法分为两组（每组24例）：对照组（A组）采用常规操作;干预组（B组）在常规操作基础上接受心理干预。观察并记录手术当日晨起（T0）、入手术室（T1）、开始操作（T2）、开始穿刺（T3）和操作结束（T4）时患者心率（HR）、平均动脉压（MAP）以及操作时间、穿刺并发症和患者满意度评分。结果B组患者各时点HR、MAP变化不大（P〉0．05）;A组患者进入手术室后各时点HR、MAP均不同程度升高（P〈0．05）;B组患者穿刺时间少于A组（P〈0．05）,满意度评分高于A组（P〈0．05）。结论对进行连续神经阻滞操作的患者进行心理干预,可以减轻应激反应,加快穿刺时间,更加满意和安全。     

Evaluation of lidocaine and tetracaine mixture in axillary brachial plexus block.

The mixture of 1% lidocaine and 0.2% tetracaine with 1:200,000 epinephrine, so-called "supercaine," has been used extensively for axillary brachial plexus blockade for several decades. Since the advent of bupivacaine, the supercaine mixture has fallen into relative disuse despite its record of effectiveness and safety. No studies have been done recently to evaluate quality of anesthesia, duration of postoperative analgesia, and degree of patient satisfaction with this mixture when used for axillary brachial plexus blockade. The assumptions were as follows: surgical anesthesia will be adequate, length of postoperative analgesia will be approximately 4 to 9 hours, and patients will be highly satisfied. The specific aim of the present study was to describe the anesthetic characteristics of supercaine. Patients between 18 and 65 years of age received a standard mixture of supercaine, totaling 450-500 mg of lidocaine and 90 to 100 mg of tetracaine. Epinephrine in a solution of 1:200,000 and an 8.4% solution of sodium bicarbonate were added, and the transarterial technique was used. Patients were contacted on postoperative day 1 to determine the duration of sensory and motor block; overall satisfaction with the block was rated. Data were analyzed with the Statistical Program for the Social Sciences (SPSS, Chicago, Ill) and Stata (Stata Corp., College Station, Tex) computer programs. The mean +/- SD findings were as follows: duration of sensory block, 465 +/- 204 minutes; duration of motor block, 473 +/- 214 minutes; patient satisfaction score, 9 +/- 1 on a 1 to 10 scale. Data are reported within a 95% confidence interval. Variables examined and compared were not statistically significant. We concluded that the duration of block supports findings reported in the literature, patients equate duration of sensory block with duration of motor block, differences in duration were probably due to levels of provider experience, and patients were extremely satisfied with the anesthetic.     

A Retrospective Study of the Incidence of Neurological Injury after Axillary Brachial Plexus Block

Background: It has been suggested that performing a nerve block under general anesthesia, as customary in pediatric population, may predispose to nerve injury. However, few clinical data exist to either support or refute this assertion. Methods: We retrospectively reviewed data on all patients who received an axillary block for upper extremity surgery in our institution during an eight‐year period. The blocks were performed under sedation or general anesthesia, without using a nerve stimulator. Perioperative records from the Hand Surgery Unit Clinic were reviewed for postoperative complaints and complications. Results: In the eight‐year period of the review, 336 patients had axillary block. In total, 230 received the block with sedation and 106 during general anesthesia. All the sedated patients were older than 14 years (mean age 45.2), while of the general anesthesia patients 48 were older than 14 years (mean age 13.9 years). There were six cases of postoperative nerve injury in sedated patients (2.6%) vs. eight cases (7.5%) in the general anesthesia patients. Most patients recovered fully within several weeks. One patient had permanent nerve injury. Conclusions: Definitive conclusions cannot be drawn because of disparities in patient group demographics (majority of pediatric patients were in the general anesthesia group) and the retrospective nature of this study. Nevertheless, the findings suggest that the conduct of axillary block under general anesthesia in pediatric patients holds a greater potential for nerve injury than when the block is performed under sedation in adults.     

左旋布比卡因用于腋路臂丛神经阻滞的疗效观察

目的观察左旋布比卡因40ml用于腋路臂丛神经阻滞的临床效果。方法ASAⅠⅡ级60例拟行肘以下骨科手术患者,随机分为左旋布比卡因组(LB组n=30)和布比卡因组(B组n=30),两组臂丛用药分别为0.375%左旋布比卡因或0.375%布比卡因40ml(150mg)。记录注药后15、30min感觉及运动阻滞效果、术后24h感觉阻滞持续时间及运动完全恢复时间、病人的总体满意度和术中不良反应。结果两组注药后15min感觉及运动阻滞效果比较无显著性差异(P>0.05);注药后30min,LB组感觉阻滞完善(Ⅲ级)的病例数明显增加(P<0.01),而且肘关节活动曲伸活动完全无力(Ⅲ级)的病例(47%)比B组(67%)低(P<0.01);LB组和B组感觉阻滞持续时间为(17.2±7.1)h及(18.9±7.3)h,运动阻滞完全恢复时间为(20.2±8.2)h及(20.5±8.4)h,两组比较无显著性差异(P>0.05);在术中LB组和B组需加用局部浸润的病例分别为4例、2例。两组比较无显著性差异(P>0.05),两组各有1例因为药物阻滞时间过长感到不适,其它病例对麻醉效果均感到满意,未发现局麻药中毒等不良反应。结论腋路臂丛神经阻滞中使用0.375%左旋布比卡因40ml,其作用与同容量的布比卡因相似。     

外周神经刺激器定位腰丛-坐骨神经阻滞在血管外科下肢手术中的应用

目的观察外周神经刺激器定位下的腰丛-坐骨神经阻滞应用于血管外科患者下肢手术的效果。方法20例血管外科拟行单侧下肢手术的患者,施行单侧腰丛-坐骨神经阻滞。腰丛阻滞为腰肌间隙入路,坐骨神经阻滞为臀区入路。采用神经刺激器定位技术,刺激器电流频率1 Hz,起始强度1 mA,麻醉总量为1%利多卡因30 mL、0.5%罗哌卡因30 mL。结果20例患者均阻滞完善,麻醉效果满意,术中生命体征平稳,血流动力学稳定。结论神经刺激器定位技术下腰丛-坐骨神经阻滞定位准确,客观指征明显,效果可靠,对患者各系统干扰小,对有严重合并症患者更为适用。     

Needle Insertion Into the Tibialis Posterior: Ultrasonographic Evaluation of an Anterior Approach

Rha D-W, Im SH, Lee SC, Kim S-K. Needle insertion into the tibialis posterior: ultrasonographic evaluation of an anterior approach.

Objective

To investigate the ultrasonographic anatomy of the lower leg for safe and accurate needle placement into the tibialis posterior using the anterior approach.

Design

Cross-sectional study.

Setting

University rehabilitation hospital.

Participants

Healthy volunteers (N=62; 30 men, 32 women).

Interventions

Not applicable.

Main Outcome Measures

The safety window (the tibia to the neurovascular bundle) and the depth to the midpoint of the safety window (skin to the tibialis posterior) at the upper third and the midpoint of the tibia were measured with a transverse ultrasonographic scan.

Results

The safety window at the upper third of the tibia was significantly larger than that at the midpoint (P<.01). The safety window ranged from .64cm to 2.13cm at the upper third tibialis point and from .32cm to 1.30cm at the midpoint. The depth to the tibialis posterior at the upper third of the tibia was significantly deeper than that in the midpoint (P<.01). The depth ranged from 2.47cm to 4.66cm at the upper third tibias point and from 2.35cm to 4.28cm at the midpoint.

Conclusions

Ultrasonography is a useful tool in measuring the safety window and the depth to the tibialis posterior using the anterior approach. Considering the safety window, we suggest the needle placement at the upper third point of tibia rather than that at the midpoint.     

外周神经刺激器引导下的锁骨下路和腋路臂丛神经阻滞效果的比较研究

目的比较神经刺激器引导下垂直锁骨下和两点法腋路臂丛神经阻滞的效果。方法60名ASAI～Ⅱ级需于臂丛神经阻滞下行前臂或手部手术的患者随机分为2组,分别行垂直锁骨下臂丛神经阻滞（组I,n=30）和两点法腋路臂丛神经阻滞（组A,n=30）。使用局麻药40mL（20mL0．5％罗哌卡因＋10mL2％利多卡因＋10mL生理盐水）,记录肌皮神经、桡神经、尺神经、正中神经、臂内侧皮神经、前臂内侧皮神经、肋间臂神经感觉阻滞情况、手臂运动阻滞情况以及成功率和相关副作用等。结果除I组肋间臂神经阻滞成功率显著高于A组外（P〈0．05）,2组在感觉阻滞和运动阻滞效果几乎没有差异,但A组有更高的血管刺破率（P〈0．05）。结论2种方法都能为外科手术提供良好的麻醉和镇痛,但垂直锁骨下方法能更好阻滞肋间臂神经而腋路方法出现刺破血管的发生率较高。