中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
6期
34-36
,共3页
杨纲华%卢增停%马钧阳%王立勋
楊綱華%盧增停%馬鈞暘%王立勛
양강화%로증정%마균양%왕립훈
臂丛%自主神经传导阻滞%老年人%神经刺激仪
臂叢%自主神經傳導阻滯%老年人%神經刺激儀
비총%자주신경전도조체%노년인%신경자격의
Brachia plexus%Autonomic nerve block%Aged%Nerve stimulator
目的 比较常规异感法和神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者上肢手术的麻醉效果.方法 将60例ASA分级Ⅱ～Ⅲ级择期行上肢手术的高龄患者按随机数字表法分为神经刺激仪组和异感法组,每组30例.神经刺激仪组采用神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞,异感法组按常规异感法行肌间沟联合腋路臂丛神经阻滞.两组所用局部麻醉药均为0.375％罗哌卡因,剂量为0.4 ml/kg.两组肌间沟、腋路臂丛神经阻滞麻醉药剂量各半.观察和记录两组患者操作时间、阻滞起效时间、镇痛持续时间、术中麻醉效果[采用疼痛视觉模拟量表(VAS)评分法]和不良反应.结果 神经刺激仪组操作时间和阻滞起效时间明显短于异感法组[(5.2±1.7) min比(8.6±2.2) min和(19.4±3.2) min比(29.0±3.9) min],术中VAS评分明显低于异感法组[(0.7±0.4)分比(2.3±0.8)分],差异均有统计学意义(P＜0.01)；神经刺激仪组和异感法组镇痛持续时间比较差异无统计学意义[(12.4±3.6)h比(13.1±3.8)h,P＞0.05].神经刺激仪组无不良反应；异感法组有5例发生不良反应,其中局部血肿2例,喉返神经麻痹1例,霍纳综合征2例.结论 神经刺激仪引导行肌间沟联合腋路臂丛神经阻滞用于高龄患者定位准确,成功率高,麻醉效果好,不良反应少,值得在临床中推广.
目的 比較常規異感法和神經刺激儀引導行肌間溝聯閤腋路臂叢神經阻滯用于高齡患者上肢手術的痳醉效果.方法 將60例ASA分級Ⅱ～Ⅲ級擇期行上肢手術的高齡患者按隨機數字錶法分為神經刺激儀組和異感法組,每組30例.神經刺激儀組採用神經刺激儀引導行肌間溝聯閤腋路臂叢神經阻滯,異感法組按常規異感法行肌間溝聯閤腋路臂叢神經阻滯.兩組所用跼部痳醉藥均為0.375％囉哌卡因,劑量為0.4 ml/kg.兩組肌間溝、腋路臂叢神經阻滯痳醉藥劑量各半.觀察和記錄兩組患者操作時間、阻滯起效時間、鎮痛持續時間、術中痳醉效果[採用疼痛視覺模擬量錶(VAS)評分法]和不良反應.結果 神經刺激儀組操作時間和阻滯起效時間明顯短于異感法組[(5.2±1.7) min比(8.6±2.2) min和(19.4±3.2) min比(29.0±3.9) min],術中VAS評分明顯低于異感法組[(0.7±0.4)分比(2.3±0.8)分],差異均有統計學意義(P＜0.01)；神經刺激儀組和異感法組鎮痛持續時間比較差異無統計學意義[(12.4±3.6)h比(13.1±3.8)h,P＞0.05].神經刺激儀組無不良反應；異感法組有5例髮生不良反應,其中跼部血腫2例,喉返神經痳痺1例,霍納綜閤徵2例.結論 神經刺激儀引導行肌間溝聯閤腋路臂叢神經阻滯用于高齡患者定位準確,成功率高,痳醉效果好,不良反應少,值得在臨床中推廣.
목적 비교상규이감법화신경자격의인도행기간구연합액로비총신경조체용우고령환자상지수술적마취효과.방법 장60례ASA분급Ⅱ～Ⅲ급택기행상지수술적고령환자안수궤수자표법분위신경자격의조화이감법조,매조30례.신경자격의조채용신경자격의인도행기간구연합액로비총신경조체,이감법조안상규이감법행기간구연합액로비총신경조체.량조소용국부마취약균위0.375％라고잡인,제량위0.4 ml/kg.량조기간구、액로비총신경조체마취약제량각반.관찰화기록량조환자조작시간、조체기효시간、진통지속시간、술중마취효과[채용동통시각모의량표(VAS)평분법]화불량반응.결과 신경자격의조조작시간화조체기효시간명현단우이감법조[(5.2±1.7) min비(8.6±2.2) min화(19.4±3.2) min비(29.0±3.9) min],술중VAS평분명현저우이감법조[(0.7±0.4)분비(2.3±0.8)분],차이균유통계학의의(P＜0.01)；신경자격의조화이감법조진통지속시간비교차이무통계학의의[(12.4±3.6)h비(13.1±3.8)h,P＞0.05].신경자격의조무불량반응；이감법조유5례발생불량반응,기중국부혈종2례,후반신경마비1례,곽납종합정2례.결론 신경자격의인도행기간구연합액로비총신경조체용우고령환자정위준학,성공솔고,마취효과호,불량반응소,치득재림상중추엄.
Objective To compare the anesthetic effect of interscalene joint axillary brachial plexus block guided by nerve stimulator or conventional paresthesia in elderly patients with upper extremity surgery.Methods Sixty cases of ASA grade Ⅱ-Ⅲ elderly patients with upper extremity surgery were divided into two groups by random number table.Nerve stimulator group (30 cases) received interscalene joint axillary brachial plexus block guided by nerve stimulator.Paresthesia group (30 cases) received interscalene joint axillary brachial plexus block guided by conventional paresthesia.Both groups used the same local anesthetic:0.375％ ropivacaine,the dosage was 0.4 ml/kg.Anesthetic dose between interscalene and axillary in two groups in half.The operating time,block onset time,duration of analgesia,anesthetic effect [used by visual analogue scale (VAS) scores] and adverse reaction in two groups were observed and recorded.Results The operating time and block onset time in nerve stimulator group were significantly shorter than those in paresthesia group[(5.2 ± 1.7) min vs.(8.6 ± 2.2) min and (19.4 ± 3.2) min vs.(29.0 ± 3.9) min],VAS scores was lower than that in paresthesia group [(0.7 ± 0.4) scores vs.(2.3 ± 0.8) scores],there were significant differences (P ＜ 0.01).There was no significant difference in duration of analgesia between two groups [(12.4 ± 3.6) h vs.(13.1 ± 3.8) h,P ＞0.05].Nerve stimulator group without adverse reactions.Paresthesia group had 5 cases of adverse reactions,including local hematoma in 2 cases,laryngeal recurrent nerve paralysis in 1 case,horner syndrome in 2 cases.Conclusion Interscalene joint axillary brachial plexus block guided by nerve stimulator in elderly patients is accurate positioning,high success rate,good anaesthesia effect,less adverse reaction,and worth promoting in clinical.
