文章摘要
超声引导锁骨下臂丛神经阻滞不同入路的临床效果
Anesthetic effects of two approaches of ultrasound-guided infraclavicular brachial plexus block
  
DOI:
中文关键词: 超声引导  锁骨中点入路  喙突入路  锁骨下臂丛神经阻滞
英文关键词: Ultrasound-guided  Medial clavicular approach  Coracoid approach  Infraclavic-ular brachial plexus block
基金项目:
作者单位
武茜 210029,南京中医药大学附属医院麻醉科 
田伟千 210029,南京中医药大学附属医院麻醉科 
郑曼 210029,南京中医药大学附属医院麻醉科 
季方兵 210029,南京中医药大学附属医院麻醉科 
杨程 210029,南京中医药大学附属医院麻醉科 
汤洋 210029,南京中医药大学附属医院麻醉科 
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中文摘要:
      目的:比较超声引导锁骨下臂丛神经阻滞锁骨中点入路与喙突入路的临床效果。方法选择拟行前臂及手外科手术患者60例,男32例,女28例,年龄18~70岁,体重50~70 kg,ASAⅠ或Ⅱ级。将患者随机分为两组,每组30例。M 组行超声引导锁骨中点入路臂丛神经阻滞(一点法),C 组行超声引导喙突入路臂丛神经阻滞(两点法),阻滞药物均为1%盐酸利多卡因与0.375%盐酸罗哌卡因混合液20 ml,C 组分2次,每次注入10 ml。记录麻醉操作时间、阻滞起效时间、麻醉维持时间、阻滞完成后5 min(T0)、10 min(T1)、15 min(T2)、20 min(T3)、25 min(T4)、30 min(T5)患者的感觉运动阻滞情况以及不良反应。结果 M 组麻醉操作时间明显短于 C 组(P <0.05);两组患者阻滞起效时间与麻醉维持时间差异无统计学意义;T0和 T1时 M 组尺神经的感觉阻滞效果明显优于 C 组(P <0.05);T0时 C 组肌皮神经的感觉阻滞效果明显优于 M 组(P <0.05);T5时两组患者的感觉和运动阻滞情况差异无统计学意义。结论超声引导锁骨中点入路与喙突入路均可安全用于臂丛神经阻滞,锁骨中点入路操作时间更短,更易掌握。
英文摘要:
      Objective To compare the anesthetic effects of ultrasound-guided infraclavicular brachial plexus block by medial clavicular approach or coracoid approach.Methods Sixty patients scheduled for forearm or hand surgery,male 32 cases,female 28 cases,aged 18-70 years,weight 50-70 kg,ASA Ⅰ or Ⅱ,patients were randomly divided into the medial clavicular approach (group M with a single-injection,n =30)and coracoid approach (group C with double-injection,n =30).Under ultrasound-guidance,20 ml of 1% lidocaine and 0.375% ropivacaine was injected for a single injection in group M,and 10 ml for each injection in group C.After the blockade,the anesthetic operation time,block onset time,anesthetic duration time were recorded.The degrees of sensory and motor block were assessed 5 min(T0 ),10 min(T1 ),1 5 min(T2 ),20 min(T3 ),25 min(T4 ),30 min(T5 ) after the end of the injection.The rate of complications was also recorded.Results The anesthetic op-eration time in group M was significantly shorter than that in group C (P <0.05),but the block on-set time and anesthetic duration time showed no statistical differences.The sensory blockade rate of ulnar nerve in group M was significantly higher than that in group C at T0 and T1 (P <0.05 ).The sensory blockade rate of musculocutaneous nerve in group C was significantly higher than that in group M at T0 (P <0.05).However,there was no significant difference in sensory and motor block-ade degree between the two groups at T5 .Conclusion Two approaches of infraclavicular brachial plexus block can be safely used.Medial clavicular approach was faster and easier to perform.
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