摘要
目的评价锁骨后入路臂丛神经阻滞用于超重患者上肢手术的效果。方法行手或腕部、前臂、肘关节手术患者60例,年龄18~64岁,性别不限,ASA分级Ⅰ或Ⅱ级,体重指数≥25 kg/m^2。采用随机数字表法分为2组(n=30):喙突旁入路组(P组)和锁骨后入路组(R组)。P组和R组在超声引导下以0.2%罗哌卡因30 ml分别行锁骨后入路或喙突旁入路臂丛神经阻滞。在局麻药注射完毕后,每10 min进行1次感觉阻滞和运动阻滞的评估,持续时间30 min,综合得分≥14分为臂丛神经阻滞成功。阻滞成功后在喉罩全身麻醉下进行手术。术毕采用舒芬太尼100μg、曲马多800 mg和托烷司琼5 mg(用生理盐水稀释至200 ml)行PCIA,背景输注速率2 ml/h,PCA剂量2 ml,锁定时间30 min,镇痛至术后72 h。术后48 h内肌肉注射帕瑞昔布钠40 mg/12 h。维持VAS评分≤3分,若VAS评分>3分时肌肉注射盐酸哌替啶100 mg补救镇痛。记录臂丛神经阻滞成功情况;记录显像时间、穿刺次数、穿刺时间、感觉阻滞持续时间和运动阻滞持续时间。记录术后72 h内补救镇痛情况和首次补救镇痛时间。术后72 h取除镇痛装置后,记录患者对术后镇痛的满意度(0分为不满意;1分为满意;2分为非常满意)。记录神经损伤、血管穿刺损伤、穿刺部位红肿、渗血、渗液等不良反应的发生情况。结果2组臂丛神经阻滞成功率均为97%。与P组比较,R组穿刺次数减少,运动阻滞持续时间延长(P<0.05),而显像时间、穿刺时间、感觉阻滞持续时间、补救镇痛率、首次补救镇痛时间、患者满意度和穿刺部位渗血发生率差异无统计学意义(P>0.05)。2组均未见感觉神经损伤、血管穿刺损伤、穿刺部位红肿、渗液等不良反应的发生。结论锁骨后入路臂丛神经阻滞可安全有效地用于超重患者上肢手术。
Objective To evaluate the efficacy of retroclavicular approach to brachial plexus block in overweight patients undergoing upper extremity surgery with general anesthesia.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 18-64 yr,with body mass index≥25 kg/m^2,undergoing hand or wrist,forearm and elbow surgery,were divided into 2 groups(n=30 each)using a random number table method:paracoracoid approach group(P group)and retroclavicular approach group(R group).The retroclavicular and paracoracoid approaches to brachial plexus block were performed with 0.2%ropivacaine 30 ml under ultrasound guidance in group P and group R,respectively.After completion of local anesthetic injection,sensory and motor blocks were evaluated every 10 min,lasting 30 min,and the comprehensive score≥14 was considered as successful brachial plexus block.The surgery was performed under general anesthesia with laryngeal mask after successful block.Patient-centrolled intravenous analgesia(PCIA)was performed after surgery.PCIA solution contained 100μg sufentanil,800 mg tramadol and 5 mg tothenesetron in normal saline 200 ml.The PCA pump was set up with a 2 ml bolus dose,a 30 min lockout interval and background infusion at a rate of 2 ml/h.Analgesia was performed until 72 h after surgery.Parecoxib sodium 40 mg/12 h was intramuscularly injected within 48 h after surgery.Visual analogue scale score was maintained≤3 points.If visual analogue scale score was>3 points,100 mg pethidine hydrochloride was intramuscularly injected as rescue analgesia.The success of brachial plexus nerve block was recorded.Imaging time,the number of puncture,puncture time,sensory block duration and motor block duration were recorded.The requirement for rescue analgesia and the first time for rescue analgesia were recorded within 72 h after surgery.The patient′s satisfaction with postoperative analgesia(0 for dissatisfaction,1 for satisfaction,2 for great satisfaction)was assessed and recorded at 72 h after surge
作者
杨光
杨波
向芮
张兰
Yang Guang;Yang Bo;Xiang Rui;Zhang Lan(Department of Anesthesiology,Sichuan Orthopedic Hospital,Chengdu 610041,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2020年第1期61-64,共4页
Chinese Journal of Anesthesiology
关键词
神经传导阻滞
臂丛
超重
Nerve block
Brachial plexus
Overweight
