CAJ | 학술논문

目的比较超声引导与神经刺激器定位锁骨上臂丛神经阻滞对上肢血流动力学参数的影响.方法选择2010年9月至2011年4月间在温州医学院附属第二医院麻醉科拟行锁骨上臂丛神经阻滞的上肢手术患者60例,美国麻醉医师协会(ASA)Ⅰ或Ⅱ级.按随机数余数分组法分为超声组(U组)与神经刺激器组(E组),每组30例.局麻药均为2％利多卡因与0.75％罗哌卡因等量混合液20 ml.采用脉冲多普勒超声测量神经阻滞前及阻滞后30 min尺、桡动脉的血流动力学参数:收缩期峰速度(PSV)、舒张末期速度(EDV)、平均速度(TAMAX)、搏动指数(PI)、阻力指数(RI)、血管横截面积(Area)及血流量(Q).注药后30 min测定感觉阻滞情况.结果两组患者阻滞前尺、桡动脉的血流参数差异无统计学意义.与E组比较,U组阻滞后尺动脉EDV和TAMAX较快(1.88倍和1.71倍)(P＜0.01),Q较高(1.84倍)(P＜0.05),PI和RI较低(P＜0.01),桡动脉EDV较快(1.47倍)(P＜0.01),PI和RI较低(P＜0.05).两组间阻滞完善患者动脉血流参数的比较,U组阻滞后尺动脉EDV和TAMAX较快(1.68倍和1.55倍)(P＜0.01),Q较高(1.62倍)(P＜0.05),PI较低(P＜0.01),桡动脉EDV和TAMAX较快(1.54倍和1.26倍)(P＜0.01或P＜0.05),PI和RI较低(P＜0.05).U组臂丛神经阻滞完善率93.3％,高于E组的73.3％ (P ＜0.05).结论超声引导较神经刺激器定位锁骨上臂丛神经阻滞明显提高上肢交感神经的阻滞效果,尤其是支配尺动脉的交感神经,可进一步增加尺动脉的血流量.
목적 비교초성인도여신경자격기정위쇄골상비총신경조체대상지혈류동역학삼수적영향.방법 선택2010년9월지2011년4월간재온주의학원부속제이의원마취과의행쇄골상비총신경조체적상지수술환자60례,미국마취의사협회(ASA)Ⅰ혹Ⅱ급.안수궤수여수분조법분위초성조(U조)여신경자격기조(E조),매조30례.국마약균위2％리다잡인여0.75％라고잡인등량혼합액20 ml.채용맥충다보륵초성측량신경조체전급조체후30 min척、뇨동맥적혈류동역학삼수:수축기봉속도(PSV)、서장말기속도(EDV)、평균속도(TAMAX)、박동지수(PI)、조력지수(RI)、혈관횡절면적(Area)급혈류량(Q).주약후30 min측정감각조체정황.결과 량조환자조체전척、뇨동맥적혈류삼수차이무통계학의의.여E조비교,U조조체후척동맥EDV화TAMAX교쾌(1.88배화1.71배)(P＜0.01),Q교고(1.84배)(P＜0.05),PI화RI교저(P＜0.01),뇨동맥EDV교쾌(1.47배)(P＜0.01),PI화RI교저(P＜0.05).량조간조체완선환자동맥혈류삼수적비교,U조조체후척동맥EDV화TAMAX교쾌(1.68배화1.55배)(P＜0.01),Q교고(1.62배)(P＜0.05),PI교저(P＜0.01),뇨동맥EDV화TAMAX교쾌(1.54배화1.26배)(P＜0.01혹P＜0.05),PI화RI교저(P＜0.05).U조비총신경조체완선솔93.3％,고우E조적73.3％ (P ＜0.05).결론 초성인도교신경자격기정위쇄골상비총신경조체명현제고상지교감신경적조체효과,우기시지배척동맥적교감신경,가진일보증가척동맥적혈류량.
Objective To compare ultrasound guidance versus nerve stimulator guidance supraclavicular brachial plexus block for regional hemodynamic changes of upper extremity.Methods Sixty ASA Ⅰ-Ⅱ patients scheduled for upper extremity operation were randomly assigned to receive a supraclavicular brachial plexus block guided by either ultrasound (U group,n =30) or nerve stimulation (N group,n =30).20 ml mixture of equal volumes of 2％ lidocaine and 0.75％ ropivacaine was injected in both groups.Regional hemodynamic parameters were measured in the ipsilateral ulnar artery and radial artery,using pulsed-wave Doppler ultrasound,before and 30 minutes after the block.Regional hemodynamic parameters included peak systolic velocity (PSV),end-diastolic velocity (EDV),time averaged maximum velocity (TAMAX),resistance index (RI),pulsatility index (PI),cross-sectional area (Area) and Blood flow (Q).The intensity of sensory block was measured at 30 minutes after the block.Results There was no significant difference in the hemodynamic parameters of ulnar artery and radial artery before the block between two groups.Compared with N group,EDV,TAMAX and Q of ulnar artery were higher in U group (1.88-fold,1.71-fold and 1.84-fold) (P ＜ 0.01 or P ＜ 0.05),PI and RI of ulnar artery were lower in U group(P ＜0.01) at 30 minutes after the block,EDV of redial artery was higher in U group(1.47-fold) (P＜0.01),PI and RI of redia] artery were lower in U group(P ＜0.05) at 30 minutes after the block.Comparing the hcmodynamic parameters of ulnar artery and radial artery with complete block between two groups at 30 minutes after the block,EDV,TAMAX and Q of ulnar artery in U group were higher than that in N group (1.68-fold,1.55-fold and 1.62-fold) (P ＜ 0.01 or P ＜ 0.05),PI of ulnar artery in U group was lower than that in N group (P ＜0.01),EDV and TAMAX of redial artery in U group was higher than that in N group (1.54-fold and 1.26-fold) (P＜0.01 or P＜0.05),PI and RI of redial artery in U group was lower than that in N group (P ＜ 0.05).The rate of complete block in U group was higher than that in N group (28/30 vs 22/30,P ＜ 0.05).Conclusion Ultrasound-guided supraclavicular brachial plexus block enhance the degree of sympathetic block of upper extremity,especially of ulnar artery and increase the blood flow of ulnar artery compared with nerve stimulator.