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| 超声引导下肋锁间隙和喙突入路锁骨下臂丛神经阻滞在前臂或手部术中效果的比较 |
| Comparison of the anesthetic effects between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via coracoid approach in operations of forearm and hand |
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| DOI：10.12089/jca.2018.04.006 |
| 中文关键词: 肋锁间隙 喙突入路 锁骨下臂丛神经阻滞 |
| 英文关键词: Costoclavicular Coracoid approach Infraclavicular brachial plexus block |
| 基金项目:陕西省教育厅面上项目(16JK1648) |
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| 中文摘要: |
| 目的 比较超声引导下肋锁间隙(CCS)臂丛神经阻滞与超声引导下喙突入路锁骨下臂丛神经阻滞在前臂或手部术中临床麻醉效果。方法 选取拟行前臂或手部手术患者58例,男33例，女25例，年龄18～70岁,ASA Ⅰ～Ⅲ级,随机分为超声引导下CCS臂丛神经阻滞组(A组)和超声引导下喙突入路锁骨下臂丛神经阻滞组(B组)。分别给予0.5％罗哌卡因20 ml,记录臂丛神经深度,神经阻滞操作时间,注射局麻药后5、10、20、30 min臂丛神经分支(正中神经、尺神经、桡神经、肌皮神经)感觉阻滞和运动阻滞情况,神经阻滞持续时间,以及麻醉相关不良反应等。结果 A组臂丛神经深度(2.0±1.2)cm，明显浅于B组(3.5±1.8)cm（P＜0.05）;A组神经阻滞操作时间(2.0±1.5) min，明显短于B组(4.0±1.5) min（P＜0.05）;注射局麻药后5、10 min A组正中神经、尺神经、桡神经、肌皮神经的感觉阻滞率均明显高于B组(P＜0.05)；注药后10 min A组尺神经、桡神经、肌皮神经的运动阻滞率明显高于B组(P＜0.05),其余时点两组运动阻滞率差异无统计学意义。两组无一例呼吸困难、恶心呕吐、耳鸣等不良反应。结论 超声引导下肋锁间隙臂丛神经阻滞较喙突入路锁骨下臂丛神经阻滞深度浅,神经阻滞穿刺操作时间更短,其感觉阻滞和运动阻滞起效更快。 |
| 英文摘要: |
| Objective To compare the effectiveness between ultrasound-guided brachial plexus block via costoclavicular approach and ultrasound-guided infraclavicular brachial plexus block via coracoid approach. Methods Fifty-eight patients scheduled for forearm or hand surgery, 33 males and 25 females, aged 18-70 years, ASA physical status Ⅰ-Ⅲ, were selected in this study. The patients were equally randomized into two groups: the group of brachial plexus block via costoclavicular approach (group A) and group of infraclavicular brachial plexus block via coracoid approach (group B). 0.5％ ropivacaine 20 ml was used for local anesthetic. The anatomic depth of brachial plexus nerve, nerve block operation time, sensory and motor blockade situation were recorded. Results Ultrasonic imaging showed the brachial plexus was shallower in group A (2.0±1.2) cm than in group B (3.5±1.8) cm (P＜0.05). Nerve block operation time in group A (2.0±1.5) min was less than that in group B (4.0±1.5) min (P＜0.05). After 5 minutes and 10 minutes of the local anesthetic injection, the sensory blockade rate of the median nerve, the ulnar nerve, the radial nerve and the muscle cutaneous nerve in group A was higher than in group B (P＜0.05). After 10 minutes of the injection, the motor blockade rate for the ulnar nerve, the radial nerve and the muscle cutaneous nerve was higher in group A than in group B (P＜0.05). There were no dyspnea, nausea, vomiting, tinnitus and other adverse reactions in the two groups. Conclusion The ultrasound-guided costoclaviculari brachial plexus block is more shallower than the subclavicular plexus block in the anatomic depth, and the nerve-blocked-operating time is shorter; at the same time, the former’s sensory and motor block effects is faster than the later. |
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