CAJ | 학술논문

目的：探讨超声引导下神经阻滞在小儿上肢手术麻醉中的应用。方法选取ASAⅠ级或Ⅱ级择期拟行上肢手术的患儿40例，随机均分为解剖定位组和超声引导组，丙泊酚靶控输注麻醉后待患儿睫毛反射消失和对言语指令无反应时，分别在常规定位法和超声引导下行肌间沟臂丛阻滞和腋路臂丛阻滞，术中根据情况吸入不同浓度的七氟醚维持麻醉深度，观察两组的神经阻滞操作时间、阻滞效果、七氟醚用量和相关并发症，并评价其安全性和临床麻醉效果。结果超声引导组完成神经阻滞操作时间明显短于解剖定位组，神经阻滞效果明显优于解剖定位组，七氟醚用量明显少于解剖定位组，麻醉后血液损伤并发症发生率明显低于解剖定位组，差异有统计学意义(P<0.05)。结论超声引导下肌间沟臂丛神经联合腋路臂丛神经阻滞能很好地满足小儿上肢手术的麻醉需要，极具优势，安全性高，与传统解剖定位方法相比，超声引导下臂丛神经阻滞可提高麻醉质量，减少全麻药用量，降低相关并发症的发生率，提高疗效，值得临床广泛推广应用。
목적：탐토초성인도하신경조체재소인상지수술마취중적응용。방법선취ASAⅠ급혹Ⅱ급택기의행상지수술적환인40례，수궤균분위해부정위조화초성인도조，병박분파공수주마취후대환인첩모반사소실화대언어지령무반응시，분별재상규정위법화초성인도하행기간구비총조체화액로비총조체，술중근거정황흡입불동농도적칠불미유지마취심도，관찰량조적신경조체조작시간、조체효과、칠불미용량화상관병발증，병평개기안전성화림상마취효과。결과초성인도조완성신경조체조작시간명현단우해부정위조，신경조체효과명현우우해부정위조，칠불미용량명현소우해부정위조，마취후혈액손상병발증발생솔명현저우해부정위조，차이유통계학의의(P<0.05)。결론초성인도하기간구비총신경연합액로비총신경조체능흔호지만족소인상지수술적마취수요，겁구우세，안전성고，여전통해부정위방법상비，초성인도하비총신경조체가제고마취질량，감소전마약용량，강저상관병발증적발생솔，제고료효，치득림상엄범추엄응용。
Objective To investigate the application of ultrasound guided nerve block in pediatric upper extremity anesthesia. Methods 40 cases of patients with ASA Ⅰ or II undergoing selective operation were selected,and were randomly divided into anatomical location group (group NS) and ultrasound guided group (group VS),After target-con-trolled infusion of propofol anesthesia when children eyelash reflex disappeared and unresponsive to verbal commands, interscalene brachial plexus block and axillary brachial plexus block was carried out by the conventional method and ultrasound guided positioning in anatomical location group and ultrasound guided group respectively.Different concen-trations of sevoflurane was inhaled to maintain the depth of anesthesia.The nerve block anesthesia operation time,anes-thesia effect,the amount of sevoflurane,and complications in two groups was observed respectively. Results The nerve block anesthesia operation time of ultrasound guided group was shorter than that of anatomical location group,anesthe-sia effect was better than that of anatomical location group,the amount of sevoflurane was less than that of anatomical location group,and the incidence rate of complication was lower than that of anatomical location group,the difference was significant (P<0.05). Conclusion Ultrasound guided interscalene brachial plexus block combined with axillary brachial plexus block can satisfy the requirement of anesthesia in pediatric upper extremity surgery,is safety.Compared with the conventional method,ultrasound guided brachial plexus block can increase the quality of anesthesia,reduce the dosage of drugs,reduce the incidence of complications,improve the efficacy,should be widely promoted in clinical application.