超声平面外技术联合神经刺激器腋路动脉旁注药臂丛神经阻滞效果研究

目的 探讨超声平面外技术联合神经刺激器引导腋路动脉旁注药臂丛神经阻滞的效果。方法 选择2015年9月—2016年9月河北医科大学第三医院单侧肘关节下骨折择期行手术治疗的60例患者进行前瞻性研究。60例患者按随机数字表法分为观察组、对照组,每组30例。观察组采用超声平面外技术联合神经刺激器行腋路动脉旁注药臂丛神经阻滞,对照组采用超声平面内技术联合神经刺激器行腋路臂丛神经阻滞。观察比较两组患者麻醉操作时间、麻醉起效时间、感觉阻滞效果、运动阻滞效果、对止血带耐受情况、麻醉并发症发生情况及手术时间。结果 两组60例患者均顺利完成手术,术中无刺破血管、局麻药中毒等并发症发生。两组间比较,观察组麻醉操作时间(6.0±1.2)min,短于对照组的(11.5±2.1)min;麻醉起效时间(13.0±1.7)min,长于对照组的(7.8±1.5)min;运动完全阻滞率为53.3%(16/30),低于对照组的90.0%(27/30),差异均有统计学意义(t=12.464、-12.781,χ²=9.932,P值均﹤0.01);而两组感觉阻滞效果、止血带耐受、手术时间等差异均无统计学意义(P值均＞0.05)。结论 超声平面外技术联合神经刺激器腋路动脉旁注药臂丛神经阻滞麻醉操作简单、安全,效果确切,有很好的临床应用价值。

The effect observation of axillary brachial plexus block injected beside the artery by ultrasound-guided out-plane and nerve stimulator

Objective To evaluate the effect of axillary brachial plexus block injected beside the artery guided by out-plane technology guided of ultrasound and nerve stimulator.Methods Sixty patients of scheduled for selected bone fracture surgery below elbow in the Third Hospital of Hebei Medical University from September 2015 to September 2016 were prospectively randomized to observation group and control group, 30 patients in each group. Patients in observation group underwent axillary brachial plexus block by out-plane technology guided of ultrasound and nerve stimulator beside axillary artery. Patients in control group performed axillary brachial plexus block by in-plane technology guided by ultrasound and nerve stimulator perineurally. The operation time, the onset time of anesthesia, sensory and motor block effect, the tourniquet tolerance, adverse events, the time of operation of two groups were recorded.Results Sixty patients were successfully completed operation, without complications such as pricking blood vessels and toxicity of local anesthetic comparition of two groups. The operation time of observation group(6.0±1.2)min was shorter than control group (11.5±2.1)min, the anesthesia onset time of observation group (13.0±1.7)min was longer than control group(7.8±1.5) min. The effect of complete motor block rate of observation group 53.3% (16/30) was lower than control group 90.0%(27/30), difference was statistically significant(t=12.464, -12.781, χ²=9.932, all P values﹤0.01). The effect of sensory block, tourniquet toleration and the operation time was similar in two group(all P values＞0.05).Conclusions The operation of axillary brachial plexus block injected beside artery guided by out-plane technology guided of ultrasound and nerve stimulator is simple, safe and effective. It has good clinical application value.