CAJ | 학술논문

目的测定颈3横突阻滞对膈肌移动度的影响;评估超声引导改良颈从阻滞的安全性和麻醉效果,并与传统一点阻滞法颈丛阻滞比较.方法第1部分:2007年9月至2008年1月温州医学院附属第一医院择期行甲状腺手术患者30例,美国麻醉医师协会(ASA)I～H级,采用超声引导双侧颈3横突阻滞和双侧皮神经阻滞,观察膈肌移动度变化.第2部分:2008年1月至2009年2月择期行甲状腺手术的患者80例,ASA I～Ⅱ级.随机分为实验组和对照组,每组40例.实验组采用超声引导改良颈丛阻滞(双侧颈3深丛和双侧颈皮神经阻滞),对照组采用传统一点法颈丛阻滞.局麻药为0.75%罗哌卡因与2%利多卡因等量混合液.观察麻醉效果和副作用.结果高频超声可以清楚显示颈部重要结构,并可引导穿刺针在横突外侧端注药.颈3横突阻滞后膈肌移动度在15、30 min显著下降,发牛膈肌部分麻痹3例,无膈肌瘫痪发生.实验组和对照组阻滞后血压、心率均较阻滞前显著增高(P<0.05或0.01);对照组在10、20 min的血压增高较实验组显著(P<0.05或0.01),在5、lO、20、30 min的心率增高也较实验组显著(P<0.05或0.01).实验组颈皮支起效时间显著早于对照组(P<0.01),麻醉效果评分显著优于对照组(P<0.01).对照组发生声音嘶哑(12例)显著高于实验组(0例)(P<0.01);发生Horner综合征2例均为对照组;使用降血压降心率药物的患者例数显著高于实验组(P<0.01).结论超声引导的改良颈丛阻滞对膈肌移动度的影响处于机体代偿范围,比传统一针法颈丛阻滞麻醉效果更好,副作用显著减少,解剖结构容易定位,适合临床应用.
목적 측정경3횡돌조체대격기이동도적영향;평고초성인도개량경종조체적안전성화마취효과,병여전통일점조체법경총조체비교.방법 제1부분:2007년9월지2008년1월온주의학원부속제일의원택기행갑상선수술환자30례,미국마취의사협회(ASA)I～H급,채용초성인도쌍측경3횡돌조체화쌍측피신경조체,관찰격기이동도변화.제2부분:2008년1월지2009년2월택기행갑상선수술적환자80례,ASA I～Ⅱ급.수궤분위실험조화대조조,매조40례.실험조채용초성인도개량경총조체(쌍측경3심총화쌍측경피신경조체),대조조채용전통일점법경총조체.국마약위0.75%라고잡인여2%리다잡인등량혼합액.관찰마취효과화부작용.결과 고빈초성가이청초현시경부중요결구,병가인도천자침재횡돌외측단주약.경3횡돌조체후격기이동도재15、30 min현저하강,발우격기부분마비3례,무격기탄탄발생.실험조화대조조조체후혈압、심솔균교조체전현저증고(P<0.05혹0.01);대조조재10、20 min적혈압증고교실험조현저(P<0.05혹0.01),재5、lO、20、30 min적심솔증고야교실험조현저(P<0.05혹0.01).실험조경피지기효시간현저조우대조조(P<0.01),마취효과평분현저우우대조조(P<0.01).대조조발생성음시아(12례)현저고우실험조(0례)(P<0.01);발생Horner종합정2례균위대조조;사용강혈압강심솔약물적환자례수현저고우실험조(P<0.01).결론 초성인도적개량경총조체대격기이동도적영향처우궤체대상범위,비전통일침법경총조체마취효과경호,부작용현저감소,해부결구용역정위,괄합림상응용.
Objective To observe the influences upon the degree of diaphragmatic excursion during deep cervical plexus block at the third cervical vertebra(C3)and compare the safety and anesthetic effect of modified cervical plexus block by ultrasonic guidance and blocking of cervical plexus at one point.Methods Part I:30 patients of ASA(American society of anesthesiologists)I-II scheduled for thyroid surgery wero selected for bilateral cervical plexus block at C3 and bilateral skin nerve branches via ultrasonic guidance.Diaphragmatic excursion was recorded.Part II:80 patients of ASA I-II scheduled for thyroid surgery were randomly divided into 2 groups:experimental group(Group U)and control group(Group C).In Group U.modified cervical plexus block was used to fix both sides of C3 and skin nenre branches.The anesthetic mixture with 2% lidocaine and 0.75%ropivacaine was injected.And anesthetic effects and complications were detected.In control group,traditional one-point method for blocking cervical plexus was employed.Results High-frequency Doppler sonography could clearly visualize important neck structures and precisely guide the injection of mixture to the transverse process of C3.Diaphragmatic excursion decreased significantly at 15 and 30 min pest-blocking(P<0.05).And no paralysis of diaphragmatic muscle occurred.Hoverer 3 cases had partial diaphragmatic paralysis.Both blood pressure and heart rate increased significantly post-blocking in both groups(P<0.05 or 0.01).In comparison with Group C,the range of blood pressure Was notably lower at 10 and 20 min in Group U.And heart rate was notably lower at 5,10,20 and 30 min(P<0.05 or 0.01).Furthermore the onset time of skin nerve branches was significantly shorter in Group U(P<0.01).And the anesthetic effect score was better than that in Group C(P<0.01).The incidence of complications,such as hoarseness,was significantly lower in Group U(12 cases in Group C but none in Group U,P<0.01)and Horner's syndrome(2 cases in Group C).The number of cases requiring hypotensor and heart rate control drug was significantly smaller in Group U than that in Group C (P<0.01).Conclusion The improving effect of ultrasound-guided cervical plexus block upon the degree of diaphragmatic movement is within the compensatory range of body.In comparison with the traditional onepoint blocking of cervical plexus,the modified cervical plexus block with ultrasonic guidance offers better anesthetic effects,fewer complications and convenient anesthetic localization.Thus it may be clinically applicable.