超声引导下锁骨上臂丛神经阻滞方法的研究

目的：将超声引导下锁骨上臂丛神经阻滞的单靶点和三靶点注射法与传统解剖定位法进行比较从而探讨单靶点和三靶点注射法阻滞的可行性及临床效果。方法：90例上肢择期手术患者，ASAI～Ⅱ级，随机分为．21ml单靶点注射组（单靶组）．7ml三靶点注射组（三靶组），21mi传统解剖定位组（传统组），局麻药为0.375％罗哌卡因和10％利多卡因的混合液记录各组的操作时间、麻醉镇痛持续时间、以及尺神经、正中神经、桡神经分布区痛觉消失的时间，评价各神经支配区域的痛觉阻滞程度（完全、部分、缺乏阻滞）和切皮时麻醉效果（优秀、良好、无效），观察并记录并发症。结果：单靶组和传统组的操作时间较三靶组短（P〈0.05），单靶组和传统组的尺神经痛觉消失时间较三靶组长（P〈0.05）与传统组相比单靶组和传统组麻醉效果的优秀率较高（P〈0.05）麻醉镇痛持续的时间延长（P〈O05）尺神经、正中神经的阻滞完全率较高（P〈0.05）而桡神经阻滞完全幸的比较三组无明显差异（P〉0.05）。单靶组和三靶组均无并发症传统组剌破血管4例，轻度局麻药中毒1例。结论：与传统解剖定位法相比，超声引导下锁骨上臂丛神经阻滞的单靶点和三靶点注射法麻醉效果较好、镇痛持续时间较长及并发症较少。三靶点注射法的操作时间较单靶点注射法长，但对尺神经的阻滞较快且较完全。

The Routing Study of Ultrasound-guided Supraclavicular Brachial Plexus Block

Objective： To compare supraclavicular brachial plexus block guided by ultrasound （single-injection and three-injection） with that guided by anatomical landmarks, in order to explore the feasibility and clinical effect of the single-injection and three-injection method. Methods： Ninety ASAI-Ⅱ patients scheduled for upper extremity operation were randomly divided into three groups： Group S （21ml single-injection）, Group T （7ml three-injection） and Group A （21ml injection by anatomical landmarks）. A mixture of local anaesthetic （0.375% ropivacaine and 1.0% lidocaine） was administered in each group. The execution time of block, duration of analgesia and complications were recorded, the time of deprivation of pain in ulnar nerve, median nerve and radial nerve were measured, the extent of sensory block of each nervated region （completeness, part, lack） and the effects of anesthesia （excellent. good. failure） during operation were assessed.Results： The operation time of block in Group S and Group A were shorter than that in Group T （P〈0.05）. The time of deprivation of pain of ulnar nerve in Group S and Group A were longer than those in Group T （P〈0.05）. The effects of pain sensory block of ulnar nerve and medial nerve in Group S-T were more complete than that in Group A （P〈0.05）, there were no significant difference in the effects of pain sensory block of radial nerve （P〉0.05）. The excellent anesthesia rate in Group S and Group T were higher than that in Group A （P〈0.05）. The duration of analgesia in Group S and Group T were longer than that in Group A （P〈0.05）. No complication occurred in Group S and Group T. 5 adverse events occurred in Group A （4 cases of vascular puncture, 1 case of mild toxic reaction）.Conclusion： Ultrasound-guided supraclavicular brachial plexus block （single-injection and three-injection） may provide more excellent block, longer duration of analgesia and fewer complications compared with that guided by anatomical landmarks. Compared with single-injection, the execution time of block was longer, but the time of deprivation of pain of ulnar nerve was shorter and the extent of ulnar nerve block was more complete in three-injection groups.