CAJ | 학술논문

目的评价超声引导近端筋膜间闭孔神经阻滞的效果.方法择期行尿道膀胱肿瘤电切术患者70例,性别不限,年龄43 ～ 82岁,体重指数18.0～ 30.5 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组(n=35):远端筋膜间闭孔神经阻滞组(R组)和近端筋膜间闭孔神经阻滞组(P组).R组在超声引导下于远端筋膜间(短收肌外侧和深面)闭孔神经后支和前支分别注射0.375％罗哌卡因7.5 ml.P组在超声引导下于近端筋膜间(耻骨肌与闭孔外肌间)闭孔神经注射0.375％罗哌卡因15.0 ml.分别于注药前(基础状态)、注药后5、10和15 min时测定阻滞侧大腿内收肌肌力,然后于L34间隙行脊椎-硬膜外联合麻醉.肌力下降程度超过50％为阻滞成功.记录闭孔神经阻滞操作时间.计算注药后各时点大腿内收肌肌力下降百分比和注药后15 min时闭孔神经阻滞成功情况.术毕对闭孔神经阻滞临床效果进行分级,并计算临床有效率(0级和1级为临床有效).结果与R组比较,P组操作时间缩短,阻滞成功率升高,注药后10和15 min时大腿内收肌肌力下降百分比升高,临床效果分级更优(P＜0.05).2组临床有效率比较差异无统计学意义(P＞0.05).结论与超声引导远端筋膜间闭孔神经阻滞相比,超声引导近端筋膜间闭孔神经阻滞操作更简便快捷,阻滞成功率更高,临床阻滞效果更好.
목적 평개초성인도근단근막간폐공신경조체적효과.방법 택기행뇨도방광종류전절술환자70례,성별불한,년령43 ～ 82세,체중지수18.0～ 30.5 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위2조(n=35):원단근막간폐공신경조체조(R조)화근단근막간폐공신경조체조(P조).R조재초성인도하우원단근막간(단수기외측화심면)폐공신경후지화전지분별주사0.375％라고잡인7.5 ml.P조재초성인도하우근단근막간(치골기여폐공외기간)폐공신경주사0.375％라고잡인15.0 ml.분별우주약전(기출상태)、주약후5、10화15 min시측정조체측대퇴내수기기력,연후우L34간극행척추-경막외연합마취.기력하강정도초과50％위조체성공.기록폐공신경조체조작시간.계산주약후각시점대퇴내수기기력하강백분비화주약후15 min시폐공신경조체성공정황.술필대폐공신경조체림상효과진행분급,병계산림상유효솔(0급화1급위림상유효).결과 여R조비교,P조조작시간축단,조체성공솔승고,주약후10화15 min시대퇴내수기기력하강백분비승고,림상효과분급경우(P＜0.05).2조림상유효솔비교차이무통계학의의(P＞0.05).결론 여초성인도원단근막간폐공신경조체상비,초성인도근단근막간폐공신경조체조작경간편쾌첩,조체성공솔경고,림상조체효과경호.
Objective To evaluate the efficacy of ultrasound-guided obturator nerve block using proximal interfascial technique.Methods Seventy ASA physical status Ⅰ or Ⅱ patients of both sexes, aged 43-82 yr, with body mass index of 18.0-30.5 kg/m2, scheduled for elective trans-urethral resection of bladder tumor, were randomly divided into 2 groups (n =35 each) using a random number table: remote interfascial technique group (group R) and proximal interfascial technique group (group P).In group R, interfascial injections at 2 planes, lateral and deep to the adductor brevis muscle, were carried out with 0.375％ ropivacaine 7.5 ml to block each obturator nerve branch separately.In group P, 0.375％ ropivacaine 15.0 ml was injected under ultrasound guidance at the interfascial plane inferior to the superior pubic ramus (between the pectineus and obturator externus).The strength of thigh adduction was measured before injection (baseline) and at 5, 10, and 15 min after injection.Then combined spinal-epidural anesthesia was performed at L3,4 interspace.The 50％ strength reduction indicated a successful block.The block performance time was recorded.The success rate of block at 15 min after injection was calculated.It was considered clinically effective when obvious muscle twitching interfering with the surgical procedure did not appear.The clinical outcome was assessed, and the effective rate of clinical outcome was calculated.Results Compared with group R, the block performance time was significantly shortened, the success rate of block, strength reduction at 10 and 15 min after injection, and clinical outcome were increased in group P.There were no significant differences in the effective rate of clinical outcome.Conclusion Compared with remote interfascial technique, ultrasound-guided obturator nerve block using proximal interfascial technique provides easier and rapid procedure, higher success rate of block and better clinical outcome of block.