中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2015年
4期
289-291
,共3页
巨积辉%关大鹏%赵强%张广亮%李祥军%侯瑞兴
巨積輝%關大鵬%趙彊%張廣亮%李祥軍%侯瑞興
거적휘%관대붕%조강%장엄량%리상군%후서흥
臂丛%感觉%运动%肌腱%粘连
臂叢%感覺%運動%肌腱%粘連
비총%감각%운동%기건%점련
Brachial plexus%Sensation%Motion%Tendon%Adhesion
目的 探讨感觉与运动分离臂丛神经阻滞麻醉在屈肌腱粘连松解手术中的应用价值.方法 自2008年3月至2012年3月,对36例肌腱粘连患者,采用超声引导下低浓度罗哌卡因做腋路臂丛神经阻滞,术中只阻滞了感觉,麻醉起效后行肌腱松解术,术中通过松解手指的主动活动来判断肌腱松解效果.结果 臂丛神经感觉阻滞有效率为100％,起效时间为(11.3±3.4)min,平均阻滞时间(85.7± 13.6)min.运动阻滞评估采用Bromage改良法,33例为0～1级,2例5级,1例4级.肌腱松解手术持续时间为30～90 min,平均50 min.术中患者疼痛评分采取VAS评分,评分0分者30例,1～2分5例,1例加用麻醉行镇痛药后完成手术,麻醉效果较满意.33例患者松解指主动屈曲效果满意,能够判断肌腱松解是否完全彻底,3例主动屈曲效果不满意.结论 用感觉与运动分离臂丛神经阻滞法可以有效地判断术中屈肌腱松解的疗效,为手术医师提供一定的参考.
目的 探討感覺與運動分離臂叢神經阻滯痳醉在屈肌腱粘連鬆解手術中的應用價值.方法 自2008年3月至2012年3月,對36例肌腱粘連患者,採用超聲引導下低濃度囉哌卡因做腋路臂叢神經阻滯,術中隻阻滯瞭感覺,痳醉起效後行肌腱鬆解術,術中通過鬆解手指的主動活動來判斷肌腱鬆解效果.結果 臂叢神經感覺阻滯有效率為100％,起效時間為(11.3±3.4)min,平均阻滯時間(85.7± 13.6)min.運動阻滯評估採用Bromage改良法,33例為0～1級,2例5級,1例4級.肌腱鬆解手術持續時間為30～90 min,平均50 min.術中患者疼痛評分採取VAS評分,評分0分者30例,1～2分5例,1例加用痳醉行鎮痛藥後完成手術,痳醉效果較滿意.33例患者鬆解指主動屈麯效果滿意,能夠判斷肌腱鬆解是否完全徹底,3例主動屈麯效果不滿意.結論 用感覺與運動分離臂叢神經阻滯法可以有效地判斷術中屈肌腱鬆解的療效,為手術醫師提供一定的參攷.
목적 탐토감각여운동분리비총신경조체마취재굴기건점련송해수술중적응용개치.방법 자2008년3월지2012년3월,대36례기건점련환자,채용초성인도하저농도라고잡인주액로비총신경조체,술중지조체료감각,마취기효후행기건송해술,술중통과송해수지적주동활동래판단기건송해효과.결과 비총신경감각조체유효솔위100％,기효시간위(11.3±3.4)min,평균조체시간(85.7± 13.6)min.운동조체평고채용Bromage개량법,33례위0～1급,2례5급,1례4급.기건송해수술지속시간위30～90 min,평균50 min.술중환자동통평분채취VAS평분,평분0분자30례,1～2분5례,1례가용마취행진통약후완성수술,마취효과교만의.33례환자송해지주동굴곡효과만의,능구판단기건송해시부완전철저,3례주동굴곡효과불만의.결론 용감각여운동분리비총신경조체법가이유효지판단술중굴기건송해적료효,위수술의사제공일정적삼고.
Objective To evaluate the clinical value of applying brachial plexus block with motor and sensory separation in flexor tenolysis of the fingers.Methodds Ultrasound-guided brachial plexus block with low concentration ropivacaine through an axillary approach was applied in 36 cases with tendon adhesion from March 2008 to March 2012.Only the sensory components were blocked during the operation and flexor tenolysis was performed after anesthesia was in effect.The effectiveness of tenolysis was judged by the active motion of the finger during the operation.Results The effective rate of brachial plexus sensory block was 100％.The onset time was (11.3 ± 3.4) minutes.The block lasted for an average of (85.7 ± 13.6) minutes.Modified Bromage method was used to assess the effect of motor block and revealed 33 cases of Grade 0 to 1,2 cases of Grade 5,and 1 case of Grade 4 blockade.The duration of the operation ranged from 30 to 90 minutes with an average of 50 minutes.Intraoperative pain was assessed on the visual analog scale (VAS),and was 0 in 30 cases and 1 to 2 in 5 cases.One case needed additional anesthesia in order to complete the operation.Overall anaesthesia effect was satisfactory.The active flexion of the finger was satisfactory in 33 cases indicating complete release of the tendon.Active finger flexion was unsatisfactory in 3 cases.Condusion Brachial plexus block with only sensory blockade allows intraoperative assessment of the effect of flexor tenolysis which is useful information for the surgeon.
