摘要
目的观察改良喙突入路臂丛神经阻滞的可行性。方法60例ASAⅠ或Ⅱ级上肢手术患者随机均分为喙突法组(A组)和腋路法组(B组),A组在喙突尖向内下2cm处绝缘针垂直于皮肤进入,B组取腋动脉上方搏动最强处进针。将神经刺激仪设置为电流1mA、频率2Hz。当电流减小到0·3mA时仍可见到正中、尺、桡神经任一神经支配区肌肉颤搐时,固定刺激针,回吸无血后注入0·5%罗哌卡因+1%利多卡因混合液30ml。比较两组的入针深度、止血带痛发生率、感觉及运动阻滞的成功率及时间。结果A组入针深度明显深于B组(P<0·05)。A组止血带痛发生率明显短于B组(P<0·05)。A组中正中、桡、肌皮、腋、臂内侧皮神经感觉完全阻滞的成功率明显高于B组(P<0·05),桡?肌皮、腋神经感觉达到完全阻滞的时间也明显短于B组(P<0·01)。A组运动完全阻滞的成功率明显高于B组(P<0·05),达到最大运动阻滞的时间也明显短于B组(P<0·01)。结论改良喙突入路法臂丛操作简便,阻滞成功率高,阻滞效果好。
Objective To evaluate the outcomes of brachial plexus block （BPB） through modified coracoid approach. Methods Sixty patients scheduled for arm surgery under BPB were randomly allocated into two groups with 30 cases each. BPB was performed through coracoid approach in group A or through axillary approach in group B directed by nerve stimulator. The nerve stimulator was programmed with the variables of current 1.0 mA and frequency 2 Hz. We inserted the needle at the edge of the axillary artery in group B or at the point 2 cm caudal and 2 cm medial to the coracoid in group A. The local anesthetics was injected when the motor response was found at one of the distal nerves （radial, ulnar or median nerve） with a current intensity of 0.3 mA. Results The needle depth of group A was significantly deeper than that of group B （P〈0.05）. The sensory block success rate in group A was significantly higher than that in group B （P〈0.05）. The complete sensory block time of three nerves （radial, musculocutaneous, and axillary nerve） in group A was significantly shorter than that in group B （P〈0.01）. The motor block success rate and the biggest motor block time in group A were significantly higher than those in group B （P〈0.01）. The biggest motor block time in group A was significantly shorter than that in group B （P〈0.01）. Conclusion The coracoid approach provides a higher BPB success rate and a greater extent of blockade than conventional axillary approach.
出处
《临床麻醉学杂志》
CAS
CSCD
2008年第4期304-306,共3页
Journal of Clinical Anesthesiology
