超声辅助下肌间沟臂丛神经阻滞在小儿上肢手术的应用

目的：探讨七氟醚吸入麻醉复合超声辅助下肌间沟臂丛神经阻滞用于小儿上肢手术的安全性及有效性。方法选取择期行上肢手术患儿60例，随机分为超声定位组和神经刺激器组，每组30例。2组患儿均在七氟醚吸入麻醉下行肌间沟臂丛神经阻滞，超声定位组采用超声辅助，神经刺激器组采用神经刺激器定位，局麻药为1%利多卡因和0.5%罗哌卡因等容量混合液（罗哌2.5 mg/ml、利多卡因5 mg/ml），按0.5 ml/kg行神经阻滞，比较2种麻醉方法的操作和起效时间、镇痛持续及恢复室停留时间，术中辅助药用量和麻醉效果和并发症的发生情况。结果2组麻醉操作时间无差异，超声定位组麻醉起效和恢复室停留时间（6.70＆#177;4.10）min，（26.82＆#177;6.70）min]明显短于神经刺激器组（8.35＆#177;1.23）min，（31.91＆#177;8.62）min]；术中辅助用药也明显少于神经刺激器组（18.60＆#177;6.50）mg vs.（22.70＆#177;8.30）mg]，其差异均有统计学意义（P＜0.05）；超声定位组镇痛持续时间明显长于神经刺激器组（451.36＆#177;16.05）min vs.（416.65＆#177;15.16）min，P＜0.05]，术中麻醉效果超声定位组明显优于神经刺激器组83%vs.60%，而血管损伤的发生率则比神经刺激器组低（6.7%vs.26.7%），差异有统计学意义，P＜0.05。结论七氟醚吸入麻醉复合超声引导下肌间沟臂丛神经阻滞用于小儿上肢手术可以明显提高麻醉效果，减少麻醉并发症，可以安全用于临床。

The application of ultrasound-assisted inter-scalene brachial plexus blockage in pediatric upper extremity operation

Objective To investigate the sevoflurane inhaled anesthesia combined with ultrasound-assisted inter-scalene brachial plexus blockage for safe and effective operation of the upper limbs in children. Methods Sixty patients undergoing upper limb operation were randomly divided into the ultrasound-assited group （group A） and nerve stimulation group （B group）, with 30 patients in each group. The two groups of children had the sevoflurane inhaled anesthesia inter-scalene brachial plexus blockage, but those in group A were ultrasound-assisted, while those in group B were with nerve stimulator, local anesthetic was conducted with equal volume of 1% lidocaine and 0.5% ropivacaine mixture （ 2.5 mg/ml lidocaine, ropivacaine 5 mg/ml）. 0.5 ml/kg concentration was used for nerve blockage. The onset time of anal-gesic anesthesia, anesthesia persistent time and the time spent in the recovery room, drug dosage for intra-operative assis-tance, the effect of anesthesia and the complications of the two approaches of operation were compared. Results There was no difference in anesthesia induction time between the two groups. The anesthesia onset time and time spent in the re-covery room in group A was significantly shorter than those in the group B. The drug used for anesthesia assistance in group A was less than group B （P＆lt;0.05）. The duration of analgesia of group A was significantly longer than that of group B （P＆lt; 0.05）, and the anesthesia effect during the surgery of group A was better than groupB. The incidence of vascular injury in group B was higher than that of group A, （P＆lt;0.05 ）. Conclusion Anesthesia with sevoflurane inhalation com-bined with ultrasound-guided interscalene brachial plexus blockage can obviously improve the anesthetic effeicacy, reduce the complications of anesthesia in children for upper limbs operation, so this approach can be safely used in clinical prac-tice.