摘要
目的采用随机对照的方法对变体位、变角度两点法与传统一点法应用于腋路臂丛神经阻滞,评估变体位、变角度两点法腋路臂丛神经阻滞的临床效果。方法选择100例拟行前臂和手部手术的急诊病人,随机分为变体位、变角度两点法组(Variable posture and angle two-point method,VTP组,n=50)和传统一点法组(The traditional one point method,TOP组,n=50),分别采用变体位、变角度两点法和传统一点法进行腋路臂丛神经阻滞,局麻药皆采用0.375%盐酸罗哌卡因45 mL。阻滞后观察对肘部远端5支神经(肌皮神经、桡神经、正中神经、尺神经和前臂内侧皮神经)支配区域的感觉和运动阻滞效果,臂丛阻滞成功被定义为注射20min后,肘部远端5支神经支配区域的感觉阻滞完全,比较两组在臂丛阻滞成功率、时效、止血带耐受和并发症等方面的差异。结果 VTP组阻滞成功率要高于TOP组(92.0%对74.0%,P<0.05),VTP肌皮神经和桡神经的阻滞成功率显著高于TOP组(P值分别为0.017和0.021)。VTP组起效、达到阻滞完善的时间明显短于TOP组(P<0.05),VTP组手术等待时间明显短于TOP组(P<0.05)。VTP组较TOP组病人能较好的耐受止血带痛(P<0.05)。结论变体位、变角度两点法腋路臂丛神经阻滞法是一种良好的阻滞方法,较传统一点法更为有效。其优点为较好的阻滞桡神经和肌皮神经,缩短麻醉起效时间和外科医师等待时间,对急诊手术具有一定的价值;有助于提高病人的满意度,减少病人止血带不适。
[Objective] To evaluate the clinical effect of axillary brachial plexus block performed by using two methods of nerve localization： variable posture and angle two-points method or the traditional one point method. [Methods] One hundred emergency patients （ASA Ⅰ-Ⅱ ） undergoing the forearm and hand surgery vere selected and randomly divided into two groups （n =50）： the variable posture and angle two-point method group （Group VTP） and the traditional one point method group （Group TOP）. Axillary brachial plexus block was performed separately with 45 mL of 0.375% ropivaeaine in two groups. Success was defined as a sensory block of the 5 nerves （median nerve, ulnar nerve, radial nerve, musculoeutaneous nerve, medial brachial cutaneous nerve） with territories distal tothe elbow 20 minutes after performing the block. The block success rate, onset time of analgesia, tourniquet toler- ance and occurrence of complication were compared between two groups. [ Results ] The success rate of group VTP was higher than that of group TOP （92.0% vs74.0%, P 〈0.05）. The blocking success rate of the radial and the mus- culocutaneous nerves in group VTP was obvious higher than that in group TOP （P 〈0.01）. Time to achieve readiness for surgery was shorter in group VTP than group TOP （P 〈0.05）. The tolerance of tourniquet pain was better in group VTP than group TOP （P 〈0.05）. [ Conclusions ] The technique of VTP is superior to the TOP as a nerve block method in axilllary brachial plexus block. Its advantage is better block the radial and the musculocutaneous nerves and reduce patients/ umcomfortcaused by tourniquet.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第34期84-88,共5页
China Journal of Modern Medicine
关键词
神经阻滞
臂丛
腋部
变体位、变角度两点法
传统一点法
nerve block
brachial plexus
axilla
variable posture and angle two-point method
the traditional one point method
作者简介
通信作者张元信，E—mial：zhangyuanxin133@163.com.
