摘要
目的评价近端-远端臂丛神经阻滞用于手外科短小手术的效果.方法行手掌及手指部位手术的患者100例,ASA分级Ⅰ或Ⅱ级,年龄18~64岁,体重45~90 kg,性别不限.采用随机数字表法分为2组(n=50):近端-远端臂丛神经阻滞组(A组)和近端臂丛神经阻滞组(B组).A组喙突旁入路给予1%利多卡因20 ml+前臂尺神经、桡神经、正中神经分别给予0.35%罗哌卡因5 ml;B组喙突旁入路给予0.35%罗哌卡因20 ml.于神经阻滞操作前5 min静脉滴注舒芬太尼0.1μg/kg,同时经10 min静脉输注右美托咪定负荷剂量0.8μg/kg,然后以0.4μg·kg^-1·h^-1的速率持续静脉输注至术毕.局麻药给药结束后15 min时,采用针刺法测定阻滞效果满意后开始手术.分别于给予局麻药结束后2、3、4、6、8、10和12 h(T1-7)时,测定上臂肌力,记录肌力恢复(肌力≥3级)情况;同时记录VAS评分,当VAS评分≥4分时,肌肉注射曲马多100 mg,记录曲马多使用情况.记录不良事件(局麻药中毒、气胸、过敏反应、神经损伤、恶心呕吐等)的发生情况,记录止血带反应发生情况.结果与B组比较,A组T2-6时点肌力恢复率升高(P<0.05),曲马多使用率差异无统计学意义(P>0.05);B组T6时开始使用曲马多,而A组T7时才开始使用曲马多.结论近端-远端臂丛神经阻滞可安全有效地用于手外科短小手术,且有利于患者术后肌力恢复快.
Objective To evaluate the effect of proximal-distal brachial plexus block for short-term operation in a department of hand surgery.Methods One hundred patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,weighing 45-90 kg,undergoing palm and finger surgery,were divided into 2 groups(n=50 each)using a random number table method:proximal-distal brachial plexus block group(group A)and proximal brachial plexus block group(group B).In group A,1%lidocaine 20 ml was given using the subclavian coracoid approach,and 0.35%ropivacaine was given for ulnar nerve,radial nerve and median nerve of forearm(5 ml for each nerve root).In group B,0.35%ropivacaine 20 ml was given through the subclavian coracoid approach.Sufentanil 0.1μg/kg was intravenously infused at 5 min before nerve block,and dexmedetomidine was intravenously infused over 10 min in a loading dose of 0.8μg/kg followed by a continuous infusion of 0.4μg·kg^-1·h^-1 until the end of operation at the same time.The blocking effect was assessed by pin-prick test at 15 min after administering local anesthetics,and the operation was started after the blocking effect was satisfactory.Muscle strength of upper arm was measured at 2,3,4,6,8,10 and 12 h after administering local anesthetics(T1-7),the recovery of muscle strength(≥grade 3)was recorded,and visual analogue scale scores were recorded at the same time.When visual analogue scale score≥4,tramadol 100 mg was intramuscularly injected,and the requirement for tramadol was recorded.The occurrence of adverse events(local anesthetic intoxication,pneumothorax,anaphylaxis,nerve injury,nausea and vomiting,etc.)was recorded,and the tourniquet reaction was recorded.Results Compared with group B,the muscle strength recovery rate was significantly increased at T2-6(P<0.05),and no significant change was found in the requirement for tramadol in group A(P>0.05).Tramadol was used at T6 in group B and at T7 in group A.Conclusion Proximal-distal brachial plexus block can be safely and effectively used for short-term operation in a department of hand surgery and is beneficial to the rapid recovery of muscle strength after operation.
作者
张进
李曼
贾海滨
张兰
Zhang Jin;Li Man;Jia Haibin;Zhang Lan(Department of Anesthesiology,Sichuan Orthopedic Hospital,Chengdu 610041,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第7期859-861,共3页
Chinese Journal of Anesthesiology
关键词
神经传导阻滞
臂丛
小外科手术
Nerve block
Brachial plexus
Minor surgical procedures
作者简介
通信作者:张兰,Email:zlzxm@163.com。
