文章摘要
超声引导下选择性臂丛神经阻滞对手腕部手术患者阻滞区域肌力恢复的影响
Effect of ultrasound-guided selective brachial plexus block on muscle strength in the block area of patients after wrist surgery
  
DOI：10.12089/jca.2024.11.004
中文关键词: 超声  选择性臂丛神经阻滞  腕部  短小手术  肌力
英文关键词: Ultrasonography  Selective brachial plexus block  Wrist  Minor surgical procedures  Muscle strength
基金项目:南通市市级科技计划（指导性）项目（MSZ2022099，MSZ023023）；如皋市科技计划资助项目［SRG（22）1086］
作者单位E-mail
任映梅 226500,南通市,江苏省如皋市人民医院,南通大学附属如皋医院麻醉科  
杨小林 226500,南通市,江苏省如皋市人民医院,南通大学附属如皋医院麻醉科 yangxiaolinrugao@163.com 
吴宏伟 226500,南通市,江苏省如皋市人民医院,南通大学附属如皋医院麻醉科  
丁颖 226500,南通市,江苏省如皋市人民医院,南通大学附属如皋医院麻醉科  
周桂云 226500,南通市,江苏省如皋市人民医院,南通大学附属如皋医院麻醉科  
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中文摘要:
      
目的： 评价超声引导下选择性臂丛神经阻滞对手腕部手术患者阻滞区域肌力恢复的影响。
方法： 选择择期行手腕部手术患者60例，男33例，女27例，年龄18～64岁，BMI 21～28 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：超声引导下前臂中段选择性臂丛神经阻滞组（A组）和超声引导下腋路臂丛神经阻滞组（B组），每组30例。A组根据手术切口位置在前臂中段选择性阻滞尺神经和（或）正中神经和（或）桡神经，每根神经注射0.4%罗哌卡因5 ml。B组在超声引导下行传统腋路臂丛神经阻滞，注射0.4%罗哌卡因30 ml。两组均于神经阻滞操作前开始泵注右美托咪定0.8 μg/kg持续10 min后，改为0.4 μg·kg-1·h-1维持至手术结束。术毕送麻醉恢复室观察30 min后返回病房。记录术后2、4、8、12、24、48 h阻滞区域肌力和肌力恢复至5级的时间。记录术后2、4、8、12、24、48 h静息和活动时VAS疼痛评分和术中止血带耐受评级。记录患者满意度评分、神经阻滞操作时间、麻醉起效时间、镇痛持续时间、术后追加镇痛药例数、术后补救镇痛的发生情况和住院时间。记录血肿、神经损伤、感染等并发症的发生情况。
结果： 与B组比较，A组术后2、4、8、12 h阻滞区域肌力评级明显升高（P<0.05），肌力恢复至5级的时间明显缩短（P<0.05），患者满意度评分明显升高（P<0.05），神经阻滞操作时间、住院时间明显缩短（P<0.05）。两组术中均能耐受止血带的使用，与B组比较，A组术中止血带耐受1级明显减少（P<0.05）。两组不同时点静息和活动时VAS疼痛评分、麻醉起效时间、镇痛持续时间、术后补救镇痛率差异无统计学意义。两组均未发生血肿、神经损伤、感染等并发症。
结论： 超声引导下选择性臂丛神经阻滞对上臂和前臂运动功能影响小，术后肌力恢复快，更适合手腕部短小手术。
英文摘要:
      
Objective: To evaluate the effect of ultrasound-guided selective brachial plexus block on postoperative muscle strength in the block area of patients after wrist surgery.
Methods: Sixty patients who underwent wrist surgery, 33 males and 27 females, aged 18-64 years, BMI 21-28 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups by random number table method: ultrasound guided selective brachial plexus block in the middle of the forearm group (group A) and ultrasound guided axillary brachial plexus block group (group B), 30 patients in each group. In group A, the ulnar nerve, and/or median nerve, and/or radial nerve were selectively blocked in the middle of the forearm according to the location of the surgical incision, and 0.4% ropivacaine was injected into each nerve with 5 ml. Patients in group B received conventional axillary brachial plexus block under ultrasound guidance and injected 30 ml of 0.4% ropivacaine. In the both two groups, dexmedetomidine 0.8 μg/kg was injected for 10 minutes before nerve block, and was changed to 0.4 μg·kg-1·h-1 until the end of operation, and then patients were transferred to the recovery room for observation 30 minutes and then returned to the ward. Muscle strength 2, 4, 8, 12, 24, 48 hours after operation and recovery time to grade 5 were recorded. VAS pain scores at rest and exercise 2, 4, 8, 12, 24, and 48 hours after surgery and tourniquet tolerance scores were recorded. Satisfaction score, nerve block operation time, anesthesia onset time, duration of analgesia, number of additional postoperative analgesics, occurrence of postoperative remedial analgesia, and length of hospital stay were recorded. Complications such as hematoma, nerve injury and infection were recorded.
Results: Compared with group B, the muscle strength score of patients in group A 2, 4, 8 and 12 hours after surgery was significantly higher (P < 0.05), the time of muscle strength recovery to level 5 in group A was significantly shorter (P < 0.05). Compared with group B, the satisfaction score in group A was better (P < 0.05), the duration of nerve block operation and hospitalization in group A was shorter (P < 0.05), the intraoperative tourniquet tolerance score of in group A was worse (P < 0.05), and both groups were tolerated. There were no significant differences in VAS pain scores at rest and exercise, the onset time of anesthesia, duration of analgesia, number of postoperative analgesia remedies between the two groups. There were no complications such as hematoma, nerve injury and infection in the two groups.
Conclusion: Ultrasound-guided selective brachial plexus block has little effect on the motor function of upper arm and forearm, and muscle strength recovers quickly after operation, can be safely and effectively adopted in short wrist surgery.
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