三种定位方法行臂丛神经阻滞的效果比较

目的探讨三种定位方法行臂丛神经阻滞的效果。方法选择择期上肢手术患者120例,随机均分成三组:超声引导组(A组)、神经刺激器组(B组)、传统方法组(C组),局麻药为2%盐酸氯普鲁卡因30ml。记录肌皮神经、桡神经、正中神经、尺神经阻滞的起效时间,并评价其阻滞完善率;评定麻醉效果(优、良、差),记录并发症。结果 A组神经阻滞起效时间较短,而C组起效时间较长,A组和B组明显短于C组,且A组短于B组(P<0.01)。A组神经阻滞完善率均接近100%,明显高于B组和C组(P<0.05或P<0.01)。麻醉效果优等率A组为95%,B组为75%,C组为47.5%,A组明显高于B、C组(P<0.05或P<0.01)。A、B组各有1例,C组有3例并发症,但三组均未出现严重并发症。结论超声引导下臂丛神经阻滞较神经刺激器辅助和传统方法下的阻滞效果良好,起效时间更短,提高了麻醉安全性和有效性。

Comparison of effects of three kinds of positioning way on brachial plexus block

Objective To compare the effects of three kinds of positioning way on brachial plexus block.Methods One hundred and twenty patients operated the upper limb were randomized into three groups (n=40 each): In group A block was guided by ultrasound ;in group B nerve stimulator was used to locate the brachial plexus and in group C block was performed in the traditional way based on anatomical landmarks.Local anesthetic was 2% chlorprocaine hydrochloride 30 ml. The onset and intensity of sensory block of musculocutaneous, median, radial and ulnar nerves were measured and analgesia was rated as excellent, effective and failure.Results Group A was the shortest in the onset time of nerve block, group B was prior than group C (P<0.01). Group A got effective nerve block rate near 100%, it was significantly higher than the group B and C (P<0.05 or P<0.01). There were significant difference among three groups in excellent rate of anesthetic effect, group A, B and C were 95%, 75% and 47.5%, respectively(P<0.05 or P<0.01). Both group A and B had 1 case of complications but 3 case in group C, no serious complications were appeared in three groups.Conclusion The brachial plexus block by ultrasounduided is better than neurostimulator and traditional method, it gets shorter onset time and more security and efficiency.