臂丛神经两点阻滞法的安全性和有效性

目的 探讨臂丛神经麻醉安全有效的阻滞方法.方法 518例上肢手术患者随机均分2组,Ⅰ组为单点阻滞组:肘以上手术采用肌间沟阻滞法,肘以下手术采用腋路阻滞法,1次完全注入局麻药40 mL; Ⅱ组为两点阻滞组:肘以上手术采用采用肌间沟加颈丛神经阻滞(C4),以肌间沟臂丛阻滞为主,肌间沟注射局麻药25mL,颈丛神经阻滞15 mL,肘以下手术采用肌间沟加腋路臂丛阻滞,以腋路臂丛阻滞为主,腋路注射局麻药混合液25 mL,肌间沟注射15mL,观察麻醉效果、术中术后并发症.结果 Ⅰ组神经阻滞成功率86.48％,明显低于Ⅱ组(96.91％),有3例改全麻插管完成手术；Ⅰ组并发症的发生率高于Ⅱ组；Ⅱ组术中血压、心率变化较Ⅰ组平稳(P＜0.05).结论 上肢手术采用肌间沟加腋路或肌间沟加颈丛两点阻滞法,能保证麻醉效果,成功率高,并且安全性和有效性均具有明显优势.

Safety and Efficacy of Brachial Plexus Nerve Block at Two Points

Objective To explore the safety and efficacy of brachial plexus nerve block at two points.Methods 518 patients undergoing upper limbs surgery were randomly divided into two groups:I group(single point block) and II group(two points block).I group:The interscalene approach nerve block was used for surgery above the elbow,and axillary approach nerve block for surgery below the elbow,40 ml of the local anesthetics was injected completely in one time.II groups:The interscalene approach and cervical plexus nerve block was used for surgery above the elbow,25 ml local anesthetics for interscalene approach and 15 ml for cervical plexus.The interscalene approach and axillary approach was used for surgery below the elbow,25 ml local anesthetics for axillary approach and 15ml for interscalene approach.The anesthetic effect and the operative complications were observed.Results The success rate of nerve block in I Group was significantly lower than II group(86.48% vs.96.91%),3 cases were changed to intubation for general anesthesia.The incidence of complications in I group was higher than that in II group.The intraoperatie blood pressure and heart rate of patients in II group were more stable than those in I group(P<0.05).Conclusion The nerve block at interscalene approach and axillary approach or interscalene approach and cervical plexus can guarantee the anesthetic effect in the upper limb surgery,has higher success rate,and higher safety and effectiveness.