组织动态测压法在小儿连续臂丛阻滞定位中的应用

目的：测定腋鞘内、外组织压力的基本范围，评估以穿刺进针过程中组织弹性变化作为主要定位判断依据的可行性。方法：80例拟行上肢手术患儿，男50例，女30例，9-12岁，ASAⅠ-Ⅱ级。随机均分为对照组和试验组，男女比例相同，行腋路臂丛阻滞，对照组采用传统定位方法，试验组采用边进针边测压的方法，评估两种定位方法的麻醉效果，观察血管、神经的损伤及局麻药中毒发生情况。结果：试验组腋鞘内组织、腋鞘外肌肉组织和皮下组织的静态压力差异均无统计学意义（P﹥0.05）；腋鞘内组织、腋鞘外肌肉组织和皮下组织5s、10s的动态压力两两之间差异均有统计学意义（P﹤0.05）。组织动态压力上升范围与以此为指导的臂丛阻滞的麻醉效果相关性良好，且以其指导的连续臂丛阻滞血管、神经的损伤发生率更低。结论：组织动态压力测定较传统定位方法更适用于小儿连续臂丛阻滞的定位。

Application of Tissue Dynamic Manometry in Positioning Continuous Brachial Plexus Block of Children

Objective：To determine the basic range of the exterior and interior tissue pressure of axillary sheath. To evalu-ate the feasibility that tissue elasticity changes were taken as a positioning criterion in the process of puncture. Methods：Eighty ASA Ⅰand Ⅱ patients scheduled for upper limb surgery,including 50 males and 30 females,aged 9 - 12 years, were randomly divided into two groups：the control group in which the traditional positioning method was applied and the experimental group in which tissue dynamic manometry was applied in the process of puncture. The sex ratio was the same. The anesthesia effects of patients were evaluated in the two groups and the happenings including blood vessel and nerve injury,the toxicity of local anesthesia were observed. Results：The static pressure difference of subcutaneous tissue and axillary sheath exterior and interior tissue had no statistical significance. But their dynamic pressure differences at the time of 5s,10s had statistical significance among them. There was a good correlation between the dynamic pressure as-cension range and the anesthesia effect of axillary brachial plexus block guided by it;there was a lower incidence rate of blood vessel and nerve injury in the experimental group guided by it. Conclusion：The tissue dynamic manometry is more applicable to children than the traditional positioning method in continuous axillary brachial plexus block.