摘要
目的 探讨感觉与运动分离臂丛神经阻滞麻醉在屈肌腱粘连松解手术中的应用价值.方法 自2008年3月至2012年3月,对36例肌腱粘连患者,采用超声引导下低浓度罗哌卡因做腋路臂丛神经阻滞,术中只阻滞了感觉,麻醉起效后行肌腱松解术,术中通过松解手指的主动活动来判断肌腱松解效果.结果 臂丛神经感觉阻滞有效率为100％,起效时间为（11.3±3.4）min,平均阻滞时间（85.7± 13.6）min.运动阻滞评估采用Bromage改良法,33例为0～1级,2例5级,1例4级.肌腱松解手术持续时间为30～90 min,平均50 min.术中患者疼痛评分采取VAS评分,评分0分者30例,1～2分5例,1例加用麻醉行镇痛药后完成手术,麻醉效果较满意.33例患者松解指主动屈曲效果满意,能够判断肌腱松解是否完全彻底,3例主动屈曲效果不满意.结论 用感觉与运动分离臂丛神经阻滞法可以有效地判断术中屈肌腱松解的疗效,为手术医师提供一定的参考.
Objective To evaluate the clinical value of applying brachial plexus block with motor and sensory separation in flexor tenolysis of the fingers.Methodds Ultrasound-guided brachial plexus block with low concentration ropivacaine through an axillary approach was applied in 36 cases with tendon adhesion from March 2008 to March 2012.Only the sensory components were blocked during the operation and flexor tenolysis was performed after anesthesia was in effect.The effectiveness of tenolysis was judged by the active motion of the finger during the operation.Results The effective rate of brachial plexus sensory block was 100％.The onset time was （11.3 ± 3.4） minutes.The block lasted for an average of （85.7 ± 13.6） minutes.Modified Bromage method was used to assess the effect of motor block and revealed 33 cases of Grade 0 to 1,2 cases of Grade 5,and 1 case of Grade 4 blockade.The duration of the operation ranged from 30 to 90 minutes with an average of 50 minutes.Intraoperative pain was assessed on the visual analog scale （VAS）,and was 0 in 30 cases and 1 to 2 in 5 cases.One case needed additional anesthesia in order to complete the operation.Overall anaesthesia effect was satisfactory.The active flexion of the finger was satisfactory in 33 cases indicating complete release of the tendon.Active finger flexion was unsatisfactory in 3 cases.Condusion Brachial plexus block with only sensory blockade allows intraoperative assessment of the effect of flexor tenolysis which is useful information for the surgeon.
出处
《中华手外科杂志》
CSCD
北大核心
2015年第4期289-291,共3页
Chinese Journal of Hand Surgery
关键词
臂丛
感觉
运动
肌腱
粘连
Brachial plexus
Sensation
Motion
Tendon
Adhesion
