CAJ | 학술논문

目的比较超声引导下锁骨上入路单靶点和三靶点注射法与传统解剖定位法臂丛神经阻滞的效果.方法择期拟行上肢手术患者90例,性别不限,ASA Ⅰ或Ⅱ级,随机分为3组(n=30):单靶点组(S组)超声引导下锁骨上臂丛神经周围注射21 ml局麻药;三靶点组(T组)超声引导下在锁骨上臂丛神经与锁骨下动脉相接位置的下方注射7 ml局麻药,再2次(各7 ml)调整穿刺针的位置形成以臂丛神经为中心的扇形注射;传统解剖定位组(A组)取锁骨中点上1 cm左右为穿刺点,注射21 ml局麻药.局麻药为0.375%罗哌卡因和1%利多卡因的混合液.记录各组操作时间和尺神经、正中神经、桡神经支配区域痛觉消失时间及镇痛持续时间;评价各神经支配区域的阻滞程度及切皮时的麻醉效果,观察并发症的发生情况.结果与A组相比,T组操作时间延长,尺神经分支配区域痛觉消失时间缩短,S组和T组麻醉效果满意率升高,镇痛持续时间延长,尺神经、正中神经的阻滞完全率升高(P＜0.05);与T组相比,S组操作时间缩短,尺神经分支配区域痛觉消失时间延长(P＜0.05);三组桡神经阻滞完全率差异无统计学意义(P＞0.05).A组刺破血管4例,轻度局麻药中毒1例,S组和T组未见并发症发生.结论与传统解剖定位法相比,超声引导下锁骨上臂丛神经阻滞的单靶点和三靶点注射法麻醉效果较好、镇痛持续时间较长,且并发症较少;三靶点注射法的操作时间较单靶点注射法长,但对尺神经的阻滞较快且完全.
목적 비교초성인도하쇄골상입로단파점화삼파점주사법여전통해부정위법비총신경조체적효과.방법 택기의행상지수술환자90례,성별불한,ASA Ⅰ혹Ⅱ급,수궤분위3조(n=30):단파점조(S조)초성인도하쇄골상비총신경주위주사21 ml국마약;삼파점조(T조)초성인도하재쇄골상비총신경여쇄골하동맥상접위치적하방주사7 ml국마약,재2차(각7 ml)조정천자침적위치형성이비총신경위중심적선형주사;전통해부정위조(A조)취쇄골중점상1 cm좌우위천자점,주사21 ml국마약.국마약위0.375%라고잡인화1%리다잡인적혼합액.기록각조조작시간화척신경、정중신경、뇨신경지배구역통각소실시간급진통지속시간;평개각신경지배구역적조체정도급절피시적마취효과,관찰병발증적발생정황.결과 여A조상비,T조조작시간연장,척신경분지배구역통각소실시간축단,S조화T조마취효과만의솔승고,진통지속시간연장,척신경、정중신경적조체완전솔승고(P＜0.05);여T조상비,S조조작시간축단,척신경분지배구역통각소실시간연장(P＜0.05);삼조뇨신경조체완전솔차이무통계학의의(P＞0.05).A조자파혈관4례,경도국마약중독1례,S조화T조미견병발증발생.결론 여전통해부정위법상비,초성인도하쇄골상비총신경조체적단파점화삼파점주사법마취효과교호、진통지속시간교장,차병발증교소;삼파점주사법적조작시간교단파점주사법장,단대척신경적조체교쾌차완전.
Objective To compare the efficacy of supraclavicular brachial plexus block guided by ultrasound(single injection and three injection)with that guided by anatomical landmarks.Methods Ninety ASAⅠ or Ⅱ patients scheduled for upper extremity operation were randomly divided into 3 groups(n = 30 each):group Ⅰ single injection with 21 ml local anesthetic guided by ultrasound(group S);group Ⅱ three injections with7 ml of local anesthetic each guided by ultrasound(group T)and group Ⅲ guided by anatomical landmarks with21 ml(group A).A mixture of 0.375% ropivacaine and 1.0% lidocaine was used.The time spent performing the block,duration of analgesia and the onset time of analgesia in the areas innervated by ulnar,median and radial nerves were measured.The degree of sensory block of the region innervated by each nerve and the effectiveness of block(excellent,good,failure)were assessed.Results The time spent performing the block was significantly shorter in group S and A than in group T.The onset time of analgesia of the area innervated by ulnar nerve was significantly shorter in group T than in group S and A.The sensory block of ulnar and median nerves was more complete in group S and T than in group A.There was no significant difference in the sensory block of radial nerve among the 3 groups.The rate of excellent anesthesia was significantly higher in group S and T than in group A.The duration of analgesia was significantly longer in group S and T than in group A.No complication occurred in group S and T while vascular puncture occurred in 4 patients and one patient developed mild toxic reaction in group A.Conclusion Ultrasound-guided supraclavicular brachial plexus block(by single or three injection)provides better block with longer duration of analgesia and fewer complications as compared with that guided by anatomical landmarks.