超声引导锁骨上臂丛神经阻滞临床效果观察

摘 要　目的：观察超声实时引导锁骨上臂丛神经阻滞应用于上肢手术病人的临床效果。方法：120例行上肢手术的病人，ASAⅠ～Ⅲ级，均行锁骨上臂丛神经阻滞，随机分为三组，每组40例：神经刺激器组（N组）和超声引导A组（UA组）的局麻药为0.5%罗哌卡因20ml，超声引导B组（UB组）的局麻药为0.375%罗哌卡因20ml。观察桡神经、正中神经、尺神经、肌皮神经、前臂内侧皮神经感觉阻滞效果和肩关节、肘关节和腕关节运动阻滞程度，评定手术全程的麻醉效果，记录并发症。结果：与N组比较， UA组和UB组感觉阻滞效果较完善(P<0.01)。与N组和UA组比较，UB组腕关节、肘关节和肩关节运动阻滞程度较轻(P<0.05)。UA组和UB的麻醉效果较N组好(P<0.01)。三组均未记录到相关并发症发生。结论：超声引导技术改善了锁骨上臂丛神经阻滞的效果，能降低局麻药浓度或用量并保证镇痛效果完善，临床应用价值较高。

Effects of ultrasound-guided supraclavicular brachial plexus block

【Abstract】Objective To evaluate the effectiveness of supraclavicular brachial plexus block guided by ultrasound. Methods One hundred and twenty ASA Ⅰ～Ⅲ patients(79 male, 31 female) aged 18-70 yrs weighing 40-80 kg scheduled for supraclavicular brachial plexus block were randomized into three groups(n=40 each): 20ml 0.5% ropivacaine was injected in Group UA (guided by ultrasound), Group N (located by nerve stimulator). 20ml 0.375% Ropivacaine was injected in Group UB (guided by ultrasound). The intensity of sensory block of the radial, median, ulnar, musculocutaneous and cutaneous nerve of forearm were measured. The intensity of motor blockade of wrist，elbow and shoulder joint and the quality of anesthesia during operation were assessed. the complications were recorded. Results The effects of sensory block in Group UA and Group UB were more complete than that in Group N (P<0.01). The motor blockade of wrist, elbow and shoulder joint in Group UB were significantly inferior to that in Group N and Group UA(P<0.01). The quality of anesthesia in Group UA and Group UB were superior to that in Group N (P<0.01). No major complication occurred in three groups. Conclusion Ultrasound guidance improves quality of blockade in supraclavicular brachial plexus regional anaesthesia and can reduce the dose of anesthetic with satisfactory anesthesia.