改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

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 musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol 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.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

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 musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol 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.     

超声引导下甲哌卡因与罗哌卡因联用对断指再植患者神经阻滞的效果

目的 评价10.00 g/L甲哌卡因与不同浓度罗哌卡因联合用于断指再植患者腋路臂丛神经阻滞的效果.方法 选择按照美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级急诊断指再植者90例,采用随机数字表法将患者分为A、B、C 3组,每组30例.各组在超声联合神经刺激器定位下行腋路臂丛神经阻滞.A组局麻药采用10.00 g/L甲哌卡因+...     

带蒂皮瓣移植修复手术诱发冻结肩的预防和治疗研究

目的 探讨手、腕部或前臂皮肤缺损进行腹部皮瓣(带蒂)修复术时诱发冻结肩的预防和治疗.方法 选择手、腕部或前臂腹部皮瓣断蒂术患者60例,分为研究组和对照组,每组30例.研究组患者采用臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉,腹部皮瓣断蒂术时兼顾对肩关节进行被动手法松解治疗和术后主动肩关节功能锻炼.对照组患者采用局麻或臂丛神经阻滞(肌间沟入路)+硬腰联合麻醉进行腹部皮瓣断蒂术.术后两组患者均进行患者静脉自控镇痛.断蒂术后2周对两组患者肩关节疼痛、Constant肩关节功能评分及肩关节活动度进行临床评估.结果 术后2周,研究组患者Constant肩关节功能评分高于对照组(P＜0.01),研究组患者肩关节疼痛及活动功能的改善情况显著优于对照组(P＜0.05),研究组患者临床治愈率、显效率明显优于对照组(P＜0.05),研究组患者麻醉效果优于对照组.结论 利用术中臂丛阻滞(肌间沟入路)复合硬腰联合麻醉提供的无痛及肌松条件,行肩关节的手法松解并且于术后配合主动的肩关节功能锻炼,能够预防和治疗带蒂皮瓣修复术后继发冻结肩,促进手及肩关节功能全面恢复,减轻术后痛苦,提高患者的生活质量.     

双侧腋路臂丛神经阻滞用于双上肢显微外科术中的探索研究

目的 探索研究双侧腋路臂丛神经阻滞用于双上肢显微外科术中的麻醉效果及安全性.方法 双上肢显微外科手术患者80例,ASA分级Ⅰ～Ⅱ级,采用随机数字表达分为两组,每组40例,臂丛组在神经刺激仪下行双侧腋路臂丛神经阻滞,全麻组采用气管插管静吸复合全身麻醉.比较两组患者麻醉前(T1)、麻醉完成时(T2),手术开始时(T3)、手术结束时(T4)的生命体征;术后2、4、8、12 h疼痛程度;术后疼痛感知时间,麻醉费用,不良反应以及术者和患者麻醉满意度.结果 血压、心率全麻组内T1时明显低于T4时(P＜0.05),组间T4时臂丛组明显低于全麻组(P＜0.05);术后2、4、8h疼痛VAS评分臂丛组明显低于全麻组(P＜0.05);术后疼痛感知时间臂丛组明显长于全麻组(P＜0.05),麻醉费用臂丛组明显低于全麻组(P＜0.05),不良反应发生率臂丛组明显低于全麻组(P＜0.05);术者和患者的麻醉满意度臂丛组明显高于全麻组(P＜0.05).结论 双侧腋路臂丛神经阻滞适合双上肢显微外科手术.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

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30 min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30 min后,2、4、6、8 h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30 min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30 min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.

Abstract：

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 musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol 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.     

应用动静分离阻滞复合镇痛技术预防术后肌腱粘连的作用

目的 探讨在感觉运动分离阻滞复合静脉镇痛的条件下,术中合理调控肌腱修复时的生理长度、张力、松紧度,以及术后无痛功能锻炼对预防术后肌腱粘连的临床效果.方法对断指再植与拇手指再造术后需行二期肌腱松解和手部肌腱转位、移植及手功能重建手术150例,用0.25%布比卡因、0.0625 mg/ml罂粟碱和0.25 mg/ml地塞米松混合液作腋腔内感觉神经与运动神经分离阻滞麻醉药物,复合使用氯诺西康自控静脉镇痛技术,观察臂丛感觉神经与运动神经阻滞效果、术中和术后镇静效果及术后3个月内需再次行肌腱松解例数.结果 臂从感觉神经阻滞综合效果优良率为96.0%,单次注药止痛时间平均达15 h以上;运动神经阻滞3h内患者术中主动伸屈手指和腕关节时,阻滞深度呈渐进性减弱,6 h达到肘关节:镇痛与镇静评分均达到了在无痛和无镇静过渡状态下完成早期体疗康复训练目的.随访150例术后因肌腱粘连需作松解10例.结论 通过恰当的臂丛感觉神经与运动神经分离阻滞方法和静脉镇痛治疗技术,在不影响肌腱愈合速度的前提下,可预防或降低术后肌腱粘连的发生.     

喉罩在小儿拇再造手术复合麻醉中的应用

喉罩（laryngeal mask airway,LMA）由于置入简单,易耐受,在小儿短小手术全身麻醉中已普遍应用［1］,但是在保留自主呼吸的长时间小儿复合麻醉中鲜有报道。小儿拇再造手术时间长,平均手术时间在5h以上,呼吸和镇痛是复合麻醉管理的难点,而通气方式是影响呼吸的主要因素。臂丛神经阻滞、腰硬联合阻滞等技术由于其创伤小、恢复快、镇痛确切等优势在小儿复合麻醉中得以广泛应用。然而在保留自主呼吸的丙泊酚复合麻醉过程中,既往多采用面罩给氧的方式,术中较多出现潮气量或呼吸频率不足继发低氧血症,给临床麻醉和手术成功带来风险。笔者拟设计一前瞻性试验,观察LMA在小儿拇再造术丙泊酚静脉麻醉复合臂丛神经阻滞、腰椎麻醉中的有效性及安全性并与传统面罩给气方式加以比较,为临床提供参考。