急诊手外伤术中2种臂丛麻醉方法的对比研究

目的：比较急诊手外伤术中2种臂丛麻醉方法的效果和安全性。方法：选取2012年10月-2014年5月间我院收治的急诊手外伤并需行手术治疗患者80例，按随机数字法分为A和B两组，每组40例患者。麻醉用药均为0.3%罗哌卡因和1.2%利多卡因的混合液。A组患者接受腋路两点阻滞法麻醉，用量为25 ml；B组患者接受肌间沟两点阻滞法麻醉，用量亦为25 ml。比较两组患者在麻醉前后的血压和心率变化、麻醉效果、不良反应的发生情况和Ramsay镇静评分得分。结果：两组患者麻醉后的血压均出现下降，且A组患者麻醉后的血压高于B组患者，差异有统计学意义（P＜0.05）。两组患者麻醉前后的心率无明显变化，麻醉效果也无明显差异。A组的总不良反应发生率为2.5%，显著低于B组的15%，差异有统计学意义（P＜0.01）。A组中Ramsay镇静评分得分为2~4分的患者比例为80%，高于B组的62.5%，差异有统计学意义（P＜0.05）。结论：急诊手外伤术中臂丛麻醉不会对患者的心率造成明显影响，腋路两点阻滞法麻醉的镇静效果较肌间沟两点阻滞法麻醉更好，可更有效地控制患者的血压、减少不良反应的发生。

Comparative study on two brachial plexus anesthesia methods in the emergency surgery of hand trauma

Objective： To compare the effect and safety of two brachial plexus anesthesia methods in the emergency surgery of hand trauma. Methods： Eighty cases of patients with emergency hand trauma, who were admitted to our hospital during October, 2012-May, 2014 and needed operation, were randomly divided into group A and B with 40 patients each. The anesthetic agent used was a mixture of 0.3%ropivacaine and 1.2%lidocaine. Patients in group A underwent axillary two block anesthesia with dosage of 25 ml while patients in group B received interscalene two block anesthesia with dosage of 25 ml. Blood pressure and heart rate before and after anesthesia, anesthesia effect, incidence of adverse reaction and Ramsay sedation scale score were compared between two groups. Results：Blood pressure in all patients decreased after anesthesia, however, it was higher in group A than in group B and the difference was statistically signiifcant （P〈0.05）. There were no obvious differences in heart rate and anesthetic effect between two groups before and after anesthesia. The total incidence of adverse reactions occurred at 2.5%in group A and 15%in group B and the difference was statistically signiifcant （P〈0.01）. The ratio with Ramsay sedation scale score 2~4 points accounted for 80%in group A, which was higher than 62.5%in group B, and the difference was statistically signiifcant （P〈0.05）. Conclusion：Brachial plexus anesthesia of acute hand injuries can not cause any signiifcant effect on heart rate in patients with axillary block anesthesia. Sedation anesthesia point method is much better than interscalene two block method and can effectively control blood pressure and reduce the adverse reaction.