摘要
目的探讨超声引导下肌间沟复合选择性腋窝臂丛神经入路能否达到上肢神经完全阻滞,以期为上肢大面积创伤所致的上肢大范围手术提供更完善的麻醉。方法将80例上肢闭合骨折患者随机分入单入路组(40例)和复合入路组(40例)。单入路组患者采用超声引导下单一入路臂丛神经阻滞(根据手术类型可采用肌间沟入路法、锁骨上入路法、锁骨下入路法、腋窝入路法),复合入路组采用超声引导下肌间沟臂丛神经阻滞复合选择性腋窝神经阻滞。记录神经阻滞的操作时间,进行感觉和运动神经阻滞评分,并记录是否需要进行补救麻醉和不良反应发生情况。结果单入路组的神经阻滞操作时间为(9.0±2.5)min,显著长于复合入路组的(6.5±2.0)min(P<0.05)。总体评估上臂神经阻滞效果,复合入路组感觉和运动阻滞评分均显著高于单入路组(P值均<0.01)。单入路组和复合入路组分别有4、1例患者术中需追加芬太尼,两组均无需其他补救麻醉。复合入路组呼吸困难和霍纳综合征的发生率分别为10.0%(4/40)和5.0%(2/40),单入路组分别为7.5%(3/40)和10.0%(4/40),两组间的差异均无统计学意义(P值均>0.05)。两组均无神经损伤、局部麻醉药中毒、气胸、局部血肿和感染等不良反应发生。结论超声引导下肌间沟复合选择性腋窝臂丛神经入路能够达到上肢神经完全阻滞。
Objective To explore the anesthetic effect of ultrasound-guided interscaiene brachial plexus block combined with selective nerve blocks in the axilla for extensive trauma in an upper limb. Methods Eighty patients with closed fracture of the upper limbs were randomized into single approach group and combined approach group （n = 40）. In single approach group, ultrasound-guided brachial plexus block was performed by a single approach （interscalene, supraclavicular, infraclavicular or axillary approach） according to the type of surgery. In combined approach group, ultrasound-guided brachial plexus block by interscalene approach combined with selective nerve blocks in the axilla. Performance time, sensory and motor blockade scores of the nerves that innervate the upper limb, incidences of rescue anesthesia and adverse events were recorded. Results Performance time in the single approach group was significantly longer than that in the combined approach group （[9.0±2.5] min vs. [6.5± 2.0] min, P〈0.05）. Sensory and motor blockage scores in the combined approach group were significantly higher than those in the single approach group （P〈0. 01）. Fentanyl was administered additionally in four patients in the single approach group and one patient in the combined approach group. No other rescue anesthesia was performed. The incidences of dyspnea and Homer syndrome were 10.0% （4/40） and 5.0% （2/40） in the combined approach group, which was not significantly different from those in the single approach group （7.5% [3/40] and 10.0% [4/40], both P〉0.05）. No other adverse events, such as nerve injury, local anesthetic intoxication, pneumothorax, hematoma or infection occurred. Conclusion Ultrasound-guided interscalene brachial plexus block and selective nerve blocks in the axilla can produce a betteranesthesia effect for operations of large area in the upper limbs.
出处
《上海医学》
CAS
CSCD
北大核心
2014年第6期469-473,F0003,共6页
Shanghai Medical Journal
关键词
臂丛
神经阻滞
超声
上肢
大面积创伤
Brachial plexus
Nerve block
Ultrasonography
Upper extremity
Extensive trauma
