超声引导联合神经刺激器在上肢臂丛神经阻滞的临床研究

目的 比较超声引导联合神经刺激器（UN）定位与单纯神经刺激器（N）定位行肌间沟臂丛神经阻滞的显影率、识别率、靶神经阻滞完成率,以及神经阻滞的效果和安全性.方法 选择ASA Ⅰ～Ⅱ级,拟行上肢手术的患者80例,随机分为UN组和N组.2组均给予1％利多卡因＋0.375％罗哌卡因20～ 30 mL.评价2组在操作中对臂丛三干神经的显影、识别及阻滞完成率,测试各支神经的感觉阻滞,术中疼痛评分.结果 UN组对肌间沟三干神经的显影率、识别率、阻滞完成率均高于N组,差异有统计学意义（P＜0.01）.对各支神经支配区域的感觉阻滞和术中疼痛评分也优于N组.N组并发症率高于UN组,差异有统计学意义（P＜0.05）.结论 超声联合神经刺激器肌间沟臂丛神经阻滞麻醉,可以在超声监控下准确的识别神经,对显影不清的神经有辅助识别作用.阻滞效果好,并发症少.

Clinical Studies of Ultrasound Guidance Combined with Nerve Stimulator in Upper Brachial Plexus Block

Objective To compare the visualization rate,the recognition rate,the target completion rate,nerve block,and the block effect and safety between ultrasound guidance combined with nerve stimulator （UN） location and single nerve stimulator （N） developing orientation for interscalene brachial plexus block.Methods Eighty patients undergoing upper limb operation,ASA grade Ⅰ-Ⅱ,were randomly divided into UN group and N group.The two groups were given 1％ lidocaine ＋0.375％ ropivacaine20-30 mL.The visualization rate of three branches of nerves in brachial plexus,the recognition rate,and the target completion rate were evaluated,and the nerve sensory block and intraoperative pain score were also evaluated in the two groups.Results In UN group,the visualization rate of three branches of nerves in brachial plexus,the recognition rate,block rate were higher than N group （P＜0.01）,the nerve sensory block and intraoperative score was better than that of N group.The incidence of complications of N group was higher than that in UN group （P＜0.05） Conclusion Ultrasound combined with nerve stimulator for interscalene brachial plexus block anesthesia,can accurately monitor and recognize nerve,has good effect in assisted identification of unclear image of nerve,good block effect and less complications.