北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2014年
4期
278-281
,共4页
儿童%手术%超声%神经阻滞
兒童%手術%超聲%神經阻滯
인동%수술%초성%신경조체
Children%Operation%Ultrasonic%Nerve block
目的：探讨七氟醚吸入麻醉复合超声辅助下肌间沟臂丛神经阻滞用于小儿上肢手术的安全性及有效性。方法选取择期行上肢手术患儿60例，随机分为超声定位组和神经刺激器组，每组30例。2组患儿均在七氟醚吸入麻醉下行肌间沟臂丛神经阻滞，超声定位组采用超声辅助，神经刺激器组采用神经刺激器定位，局麻药为1%利多卡因和0.5%罗哌卡因等容量混合液（罗哌2.5 mg/ml、利多卡因5 mg/ml），按0.5 ml/kg行神经阻滞，比较2种麻醉方法的操作和起效时间、镇痛持续及恢复室停留时间，术中辅助药用量和麻醉效果和并发症的发生情况。结果2组麻醉操作时间无差异，超声定位组麻醉起效和恢复室停留时间[（6.70±4.10）min，（26.82±6.70）min]明显短于神经刺激器组[（8.35±1.23）min，（31.91±8.62）min]；术中辅助用药也明显少于神经刺激器组[（18.60±6.50）mg vs.（22.70±8.30）mg]，其差异均有统计学意义（P＜0.05）；超声定位组镇痛持续时间明显长于神经刺激器组[（451.36±16.05）min vs.（416.65±15.16）min，P＜0.05]，术中麻醉效果超声定位组明显优于神经刺激器组83%vs.60%，而血管损伤的发生率则比神经刺激器组低（6.7%vs.26.7%），差异有统计学意义，P＜0.05。结论七氟醚吸入麻醉复合超声引导下肌间沟臂丛神经阻滞用于小儿上肢手术可以明显提高麻醉效果，减少麻醉并发症，可以安全用于临床。
目的：探討七氟醚吸入痳醉複閤超聲輔助下肌間溝臂叢神經阻滯用于小兒上肢手術的安全性及有效性。方法選取擇期行上肢手術患兒60例，隨機分為超聲定位組和神經刺激器組，每組30例。2組患兒均在七氟醚吸入痳醉下行肌間溝臂叢神經阻滯，超聲定位組採用超聲輔助，神經刺激器組採用神經刺激器定位，跼痳藥為1%利多卡因和0.5%囉哌卡因等容量混閤液（囉哌2.5 mg/ml、利多卡因5 mg/ml），按0.5 ml/kg行神經阻滯，比較2種痳醉方法的操作和起效時間、鎮痛持續及恢複室停留時間，術中輔助藥用量和痳醉效果和併髮癥的髮生情況。結果2組痳醉操作時間無差異，超聲定位組痳醉起效和恢複室停留時間[（6.70±4.10）min，（26.82±6.70）min]明顯短于神經刺激器組[（8.35±1.23）min，（31.91±8.62）min]；術中輔助用藥也明顯少于神經刺激器組[（18.60±6.50）mg vs.（22.70±8.30）mg]，其差異均有統計學意義（P＜0.05）；超聲定位組鎮痛持續時間明顯長于神經刺激器組[（451.36±16.05）min vs.（416.65±15.16）min，P＜0.05]，術中痳醉效果超聲定位組明顯優于神經刺激器組83%vs.60%，而血管損傷的髮生率則比神經刺激器組低（6.7%vs.26.7%），差異有統計學意義，P＜0.05。結論七氟醚吸入痳醉複閤超聲引導下肌間溝臂叢神經阻滯用于小兒上肢手術可以明顯提高痳醉效果，減少痳醉併髮癥，可以安全用于臨床。
목적：탐토칠불미흡입마취복합초성보조하기간구비총신경조체용우소인상지수술적안전성급유효성。방법선취택기행상지수술환인60례，수궤분위초성정위조화신경자격기조，매조30례。2조환인균재칠불미흡입마취하행기간구비총신경조체，초성정위조채용초성보조，신경자격기조채용신경자격기정위，국마약위1%리다잡인화0.5%라고잡인등용량혼합액（라고2.5 mg/ml、리다잡인5 mg/ml），안0.5 ml/kg행신경조체，비교2충마취방법적조작화기효시간、진통지속급회복실정류시간，술중보조약용량화마취효과화병발증적발생정황。결과2조마취조작시간무차이，초성정위조마취기효화회복실정류시간[（6.70±4.10）min，（26.82±6.70）min]명현단우신경자격기조[（8.35±1.23）min，（31.91±8.62）min]；술중보조용약야명현소우신경자격기조[（18.60±6.50）mg vs.（22.70±8.30）mg]，기차이균유통계학의의（P＜0.05）；초성정위조진통지속시간명현장우신경자격기조[（451.36±16.05）min vs.（416.65±15.16）min，P＜0.05]，술중마취효과초성정위조명현우우신경자격기조83%vs.60%，이혈관손상적발생솔칙비신경자격기조저（6.7%vs.26.7%），차이유통계학의의，P＜0.05。결론칠불미흡입마취복합초성인도하기간구비총신경조체용우소인상지수술가이명현제고마취효과，감소마취병발증，가이안전용우림상。
Objective To investigate the sevoflurane inhaled anesthesia combined with ultrasound-assisted inter-scalene brachial plexus blockage for safe and effective operation of the upper limbs in children. Methods Sixty patients undergoing upper limb operation were randomly divided into the ultrasound-assited group (group A) and nerve stimulation group (B group), with 30 patients in each group. The two groups of children had the sevoflurane inhaled anesthesia inter-scalene brachial plexus blockage, but those in group A were ultrasound-assisted, while those in group B were with nerve stimulator, local anesthetic was conducted with equal volume of 1% lidocaine and 0.5% ropivacaine mixture ( 2.5 mg/ml lidocaine, ropivacaine 5 mg/ml). 0.5 ml/kg concentration was used for nerve blockage. The onset time of anal-gesic anesthesia, anesthesia persistent time and the time spent in the recovery room, drug dosage for intra-operative assis-tance, the effect of anesthesia and the complications of the two approaches of operation were compared. Results There was no difference in anesthesia induction time between the two groups. The anesthesia onset time and time spent in the re-covery room in group A was significantly shorter than those in the group B. The drug used for anesthesia assistance in group A was less than group B (P<0.05). The duration of analgesia of group A was significantly longer than that of group B (P< 0.05), and the anesthesia effect during the surgery of group A was better than groupB. The incidence of vascular injury in group B was higher than that of group A, (P<0.05 ). Conclusion Anesthesia with sevoflurane inhalation com-bined with ultrasound-guided interscalene brachial plexus blockage can obviously improve the anesthetic effeicacy, reduce the complications of anesthesia in children for upper limbs operation, so this approach can be safely used in clinical prac-tice.
