不同定位方法对臂丛神经阻滞麻醉的效果比较

目的对比利用超声定位与解剖定位2种方法行臂丛神经阻滞的麻醉效果。方法选择68例上肢手术患者，随机分为超声定位组与解剖定位组，超声定位组通过超声定位，解剖定位组通过体表标志定位，2组使用相同的局麻药混合液，均为1．000％盐酸利多卡因和0．375％盐酸罗哌卡因混合液。记录麻醉完成时间及起效时间，用药剂量，采用VAS法判定麻醉效果，记录麻醉不良反应，计量资料以（x-±S）表示，采用t检验。计数资料以频数表示，采用x。检验进行统计分析，以P〈0．05为差异有统计学意义。结果超声组患者的操作时间为（3．114-1．32）min，VAS评分为（2．86±0．52）分；传统组患者的操作时间为（5．91±2．24）min，VAS评分为（4．11±0．82）分。2组患者在操作时间和麻醉效果评分上差异具有统计学意义（t=6．282、7．511，P均〈0．01）。超声组患者中仅发生1例Honer综合征，而传统组中发生6例Honer综合征，3例局麻药毒性反应，5例血肿，1例气胸，2组在Honer综合征以及血肿发生率上差异具有统计学意义（X2=5．983、5．402，P均〈0．05）。结论超声组与传统组相较，麻醉时间短，麻醉效果好，不良反应发生率低，是一种安全有效的方法。

Comparison of ultrasound-guided vs. anatomical landmark-guided axillary brachial plexus block

Objective To explore the clinical effect and safety of ultrasound-guided and anatomical landmark-guided axil- lary brachial plexus block. Methods Total 68 patients scheduled for upper limb surgery were randomly divided into ultrasound-guided group and anatomical landmark-guided group with 34 cases in each group. The same local anesthetics with 1% lidocaine hydrochloride and 0.375% ropivacaine hydrochloride were performed in both groups. The anesthesia finish, onset of anesthesia, dosage of anesthetics and side effect were analyzed. The anesthetic effect was assessed using visual analogue scale （VAS）. T-test and Chi-square test were employed to analyze the results. Results In the ultrasoundguided group,the operating time was （3.11 ± 1.32） min and VAS was （2.86 ±0.52） ; in the anatomical landmark- guided group,the operation time was（5.91 _＋2.24） min and VAS was （4.11 ±0.82）%. The difference in the operation time and the anesthesia effect was statistical significant between two groups （ t= 6. 282,7.511, P 〈 0.01 ）. There was one case of Honer syndrome in the ultrasound-guided group, while there were 6 cases of Honer syndrome,3 cases of local anesthetic toxicity reaction ,5 cases of hematoma, and 1 case of pneumothorax ; the difference in the incidence of honer syndrome and hematoma was statistically significant （X2 = 5. 983,5. 402 ,P 〈 0.05 ）. Conclusion As compared to the anatomical landmark-guided axillary brachial plexus block, ultrasound-guided brachial plexus block can achieve good anesthetic effect, and reduce the adverse reactions.