中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
6期
525-527
,共3页
徐志新%吉芳%艾来提%尹极峰
徐誌新%吉芳%艾來提%尹極峰
서지신%길방%애래제%윤겁봉
臂丛%神经传导阻滞%桡神经%电刺激
臂叢%神經傳導阻滯%橈神經%電刺激
비총%신경전도조체%뇨신경%전자격
Brachial plexus%Nerve block%Radial nerve%Electric stimulation
目的 评价臂丛神经阻滞时神经刺激器诱发患者不同运动反应与桡神经阻滞效果的关系.方法 择期拟行手、腕或前臂手术患者120例,性别不限,ASA I或Ⅱ级,年龄18～60岁,随机分为2组(n=60),三点腋路臂丛神经阻滞在周围神经刺激器引导下,采用1%利多卡因与0.33%罗哌卡因混合液注射于肌皮神经、正中神经,分别为5、10 ml,I组和Ⅱ组分别诱发前臂外展或腕及手指外展时,采用上述混合液20 ml注射于桡神经周围,于注射完毕后5、10、15、20、25和30 min时采用针刺法评价肌皮神经、正中神经的感觉阻滞情况,桡神经近端和远端的感觉及运动阻滞情况.记录神经阻滞操作时间,记录桡神经定位次数,评价桡神经定位的难易程度.结果 与I组相比,Ⅱ组感觉完全阻滞成功率高,桡神经远端感觉及运动阻滞成功率高,神经阻滞操作时间长,桡神经定位困难程度高(P<0.05或0.01).结论 臂丛神经阻滞时,当神经刺激器诱发患者腕及手指外展较诱发前臂外展应用1%利多卡因与0.33%罗哌卡因混合液20 ml阻滞桡神经的效果更完善.
目的 評價臂叢神經阻滯時神經刺激器誘髮患者不同運動反應與橈神經阻滯效果的關繫.方法 擇期擬行手、腕或前臂手術患者120例,性彆不限,ASA I或Ⅱ級,年齡18～60歲,隨機分為2組(n=60),三點腋路臂叢神經阻滯在週圍神經刺激器引導下,採用1%利多卡因與0.33%囉哌卡因混閤液註射于肌皮神經、正中神經,分彆為5、10 ml,I組和Ⅱ組分彆誘髮前臂外展或腕及手指外展時,採用上述混閤液20 ml註射于橈神經週圍,于註射完畢後5、10、15、20、25和30 min時採用針刺法評價肌皮神經、正中神經的感覺阻滯情況,橈神經近耑和遠耑的感覺及運動阻滯情況.記錄神經阻滯操作時間,記錄橈神經定位次數,評價橈神經定位的難易程度.結果 與I組相比,Ⅱ組感覺完全阻滯成功率高,橈神經遠耑感覺及運動阻滯成功率高,神經阻滯操作時間長,橈神經定位睏難程度高(P<0.05或0.01).結論 臂叢神經阻滯時,噹神經刺激器誘髮患者腕及手指外展較誘髮前臂外展應用1%利多卡因與0.33%囉哌卡因混閤液20 ml阻滯橈神經的效果更完善.
목적 평개비총신경조체시신경자격기유발환자불동운동반응여뇨신경조체효과적관계.방법 택기의행수、완혹전비수술환자120례,성별불한,ASA I혹Ⅱ급,년령18～60세,수궤분위2조(n=60),삼점액로비총신경조체재주위신경자격기인도하,채용1%리다잡인여0.33%라고잡인혼합액주사우기피신경、정중신경,분별위5、10 ml,I조화Ⅱ조분별유발전비외전혹완급수지외전시,채용상술혼합액20 ml주사우뇨신경주위,우주사완필후5、10、15、20、25화30 min시채용침자법평개기피신경、정중신경적감각조체정황,뇨신경근단화원단적감각급운동조체정황.기록신경조체조작시간,기록뇨신경정위차수,평개뇨신경정위적난역정도.결과 여I조상비,Ⅱ조감각완전조체성공솔고,뇨신경원단감각급운동조체성공솔고,신경조체조작시간장,뇨신경정위곤난정도고(P<0.05혹0.01).결론 비총신경조체시,당신경자격기유발환자완급수지외전교유발전비외전응용1%리다잡인여0.33%라고잡인혼합액20 ml조체뇨신경적효과경완선.
Objective To investigate the relationship between different motor responses evoked by nerve stimulator and efficacy of radial nerve block during brachial plexus block in patients. Methods One hundred and twenty ASA I or II patients aged 18-60 yr scheduled for hand, wrist or forearm surgery were randomly allocated into 2 groups ( n = 60 each) . The triple-injection axillary brachial plexus block was performed under the guidance of peripheral nerve stimulator. The mixture of 1% lidocaine and 0.33% ropivacaine was injected around the musculocutaneous nerve (S ml) and median nerve (10 ml) . When forearm extension in group I and the wrist and finger extension in group II were evoked, 20 ml of the mixture mentioned above was injected around the radial nerve. Sensory blocks of musculocutaneous and median nerves, sensory and motor blocks of the proximal or distal branches of the radial nerve were assessed at 5-min intervals in 30 min after the injection was completed. The time to perform the block and number of locating the radial nerve were recorded. Results The success rate of complete sensory block was significantly higher, the success rate of sensory and motor blocks of the distal branches of the radial nerve was significantly higher, the time to perform the block was significantly longer, and the localization of the radial nerve was more difficult in group II than in group I ( P < 0.05 or 0.01). Conclusion The wrist and finger extension evoked by peripheral nerve stimulator predicts better efficacy than forearm extension in triple-injection axillary brachial plexus block with 20 ml mixture of 1 % lidocaine and 0.33 % ropivacaine.
