CAJ | 학술논문

目的探讨超声引导肌间沟臂丛神经阻滞在急诊上肢手术中应用的可行性.方法 2007年8月至2007年12月于温州市中西医结合医院行急诊上肢手术的患者80例(男53例,女27例),ASAⅠ～Ⅱ级,颈肩部外观无畸形,无患肢感觉异常,无肌间沟臂丛神经阻滞禁忌证,年龄18～68岁,体质量45～75kg.随机分为二组进行前瞻性的临床对照研究:超声引导组(U组)和神经刺激器引导组(N组),每组各40例,分别行超声和神经刺激器引导的肌间沟臂丛神经阻滞,两组患者性别、年龄、体质量和手术时间差异无统计学意义(P＞0.05).局麻药为0.75%罗哌卡因与2%利多卡因等量混合液20 mL.组间观察比较腋神经、臂外侧皮神经、桡神经、正中神经、臂内侧皮神经、前臂内侧皮神经、尺神经的麻醉起效时间、阻滞效果和麻醉持续时间;评定手术全程的麻醉效果.采用SPSS12.0统计学软件包进行独立样本t检验、秩和检验和χ2检验,以P＜0.05为差异具有统计学意义.结果各神经分支起效时间比较,U组明显短于N组(P＜0.01).注药30min后,各神经分支的阻滞效果U组明显优于N组(P＜0.05).U组麻醉优良率明显高于N组(100%vs.87.5%,P＜0.05).N组失败5例,其中2例追加其他途径臂丛神经阻滞,3例改为全麻后完成手术.麻醉持续时间U组为(378±151)min,N组为(365±163)min,两组差异无统计学意义(P＞0.05).N组出现5例误穿血管.结论与神经刺激器比较,超声引导肌间沟臂丛神经阻滞的起效时间更短,阻滞效果更好,是急诊上肢手术理想的臂丛神经阻滞方法.
목적 탐토초성인도기간구비총신경조체재급진상지수술중응용적가행성.방법 2007년8월지2007년12월우온주시중서의결합의원행급진상지수술적환자80례(남53례,녀27례),ASAⅠ～Ⅱ급,경견부외관무기형,무환지감각이상,무기간구비총신경조체금기증,년령18～68세,체질량45～75kg.수궤분위이조진행전첨성적림상대조연구:초성인도조(U조)화신경자격기인도조(N조),매조각40례,분별행초성화신경자격기인도적기간구비총신경조체,량조환자성별、년령、체질량화수술시간차이무통계학의의(P＞0.05).국마약위0.75%라고잡인여2%리다잡인등량혼합액20 mL.조간관찰비교액신경、비외측피신경、뇨신경、정중신경、비내측피신경、전비내측피신경、척신경적마취기효시간、조체효과화마취지속시간;평정수술전정적마취효과.채용SPSS12.0통계학연건포진행독립양본t검험、질화검험화χ2검험,이P＜0.05위차이구유통계학의의.결과 각신경분지기효시간비교,U조명현단우N조(P＜0.01).주약30min후,각신경분지적조체효과U조명현우우N조(P＜0.05).U조마취우량솔명현고우N조(100%vs.87.5%,P＜0.05).N조실패5례,기중2례추가기타도경비총신경조체,3례개위전마후완성수술.마취지속시간U조위(378±151)min,N조위(365±163)min,량조차이무통계학의의(P＞0.05).N조출현5례오천혈관.결론 여신경자격기비교,초성인도기간구비총신경조체적기효시간경단,조체효과경호,시급진상지수술이상적비총신경조체방법.
Objective To investigate the feasibility of ultrasound-guided interscalenus brachial plexus block used for the emergency surgery.Method From August to December 2007 80 patients from the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou,ASA Ⅰ to Ⅲ,age 18 to 68 years old,weight 45 to 75 kg,without deformity on the shoulder or neck,without limb paresthesia,without contraindications of interscalenus brachial plexus block,were scheduled for emergency surgery of upper limb.They were randomly divided into two groups:interscalenus block guided by ultrasound group(group U,re =40)and nerve stimulator group(group N,re = 40).Patients of both groups received 20 mL mixture of 0.75%ropivacaine and 2%lidocaine.The onset time,and the analgesic efficacy of axillary nerve,lateral antebrachial cutaneous nerve,radial nerve,median nerve,median cutaneous nerve of arm,median antebrachial cutaneous nerve and ulnar nerve,and duration of anesthesia were observed.Statistical analysis was performed by t test,rank sum test and X2 test.Results The onset time of analgesia after nerve block was shorter in group U than that in group N(P＜0.01).The rate of perfect analgesia after nerve block in group U was higher than that in group N(100%vs.87.5%,X2 = 5.267,P = 0.027).The duration of anesthesia lasted in group U was(378 ± 151)minutes and that in group N was(365 ± 163)minutes(t= 0.363,P = 0.718).ConclusionsCompared with the method of nerve block guided by nerve stimulator,the ultrasound-guided interscalenus block offers faster onset and better analgesic efficacy.It is an ideal technique of brachial plexus block for the emergency surgery.