摘要
目的比较垂直锁骨下臂丛神经阻滞两种定位方法的准确性和安全性。方法择期上肢手术患者110例,ASAⅠ或Ⅱ级,随机分为2组(n=55):K组采用Kilka介绍的定位方法行垂直锁骨下臂丛神经阻滞,穿刺点位于肩峰腹侧突与胸骨颈静脉切迹连线(K线)的中点;G组采用Greher介绍的定位方法行垂直锁骨下臂丛神经阻滞,根据K线的长度对Kilka定位方法的穿刺点予以校正。所有穿刺成功患者给予0.5％罗哌卡因40ml。记录两种方法的试穿次数、进针深度和注药后正中、桡、尺、腋、肌皮和前臂内侧皮神经阻滞的起效时间,观察有无刺破血管、气胸等并发症。结果K组和G组首次穿刺成功率分别为50．9％和14．5％(P<0.01),前3次试穿总成功率分别为83．6％和47．3％(P <0．01),放弃率分别为7．3％和10．9％(P>0．05)。穿刺成功的100例进针深度平均为35(25-49) mm。K组发生刺破血管2例,G组发生刺破血管1例、局麻药中毒1例。结论就成功率而言,Kilka方法是一种较好的穿刺点定位方法,适用于成年患者垂直锁骨下臂丛神经阻滞。
Objective To compare the accuracy and safety of two methods of locating the point of needle entry for vertical infraclavicular brachial plexus block. Methods One hundred and ten ASA Ⅰ or Ⅱ patients of both sexes weighing 45-90 kg undergoing upper extremity surgery were randomly divided into 2 groups ： group K and group G. In group K the method of Kilka was used. The needle was inserted at the midpoint of an infraclavicular Line connecting the jugular fossa and the ventral process of the acromion （K-line）. In group G Greber＇s method was used. It is actually a corrected IGlka method. If the K-line is 22.0-22.5 cm long the needle is inserted at the midpoint of the K-line as in group K. If not the point of needle entry is moved 2 mm medially from the midpoint for every 1 cm increase in K-line or laterally for every 1 cm decrease in K-line. The puncture of brachial plexus was confirmed by electrical stimulation which elicited tremor of Ⅰ -Ⅲ fingers. The number of attempts, the depth of needle insertion and the side effects were recorded. The onset of sensory block was determined by pinprick. Results The brachial plexus was successfully punctured at first attempt in 50.9 % of the patients in group K and 14.5% in group G （P 〈 0.01）. The brachial plexus was successflly punctured within 3 attempts in 83.6% of patients in group K and 47.3% in group G （ P 〈 0.01）. The rate of failure was 7.3% in group K and 10.9% in group G. The mean value of the depth of needle insertion was 35 mm （25-49 mm） for 100 patients of successful puncture. No patient developed pneumothorax. There were two cases of vascular puncture in group K, one case of vascular puncture and one case of systemic local anesthetic toxication in group G. Conclusions Kilka method is a better method of locating the point of needle entry for vertical infraclavicular brachial plexus in terms of successful rate. The depth of needle insertion should not exceed 50 mm.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第12期1081-1084,共4页
Chinese Journal of Anesthesiology
关键词
臂丛
神经传导阻滞
方法
Brachial plexus
Nerve block
Methods
