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超声引导肌间沟和选择腋窝阻滞在上肢严重创伤中的应用
Ultrasound-guided interscalene and selective nerve blocks in the axilla for patients with extensive trauma in an upper limb
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DOI:
作者:
刘溪 王爱忠 赵达强 李静 张晖 江伟
LIU Xi ,WANG Ai-zhong ,ZHAO Da-qiang ,LI-Jing ,ZHA
作者单位:
上海交大附属第六人民医院
the 6th People’s Hospital,Shanghai Jiaotong University
关键词:
臂丛;神经阻滞;超声;上肢;大面积创伤
Brachial plexus; Nerve block; Ultrasonography; Upper extremity
摘要:
目的 此研究旨在探究超声引导肌间沟臂丛阻滞复合选择性腋窝神经阻滞能否为上肢手术患者提供更完善的麻醉,以期解决上肢大面积创伤患者的阻滞困难。方法 80位上肢某一部位闭合骨折患者,随机分为单入路组(S组,n=40)和复合入路组(C组,n=40)。S组:根据手术类型,采用超声引导单一入路阻滞(肌间沟入路法,锁骨上入路法,锁骨下入路法,腋窝入路法);C组:采用超声引导肌间沟臂丛阻滞复合选择性腋窝神经阻滞。记录神经阻滞操作时间、上肢感觉及运动神经阻滞评分,是否需要补救麻醉和不良反应发生率。结果 C组感觉和运动神经阻滞评分均高于S组(p = 0.000, p = 0.002),C组神经阻滞操作时间也长于S组(9.0 ± 2.5 min和6.5 ± 2.0 min, p = 0.001)。需要补救麻醉及发生不良反应的患者人数差异两组间无统计学意义。结论 超声引导下肌间沟臂丛阻滞复合选择性腋窝神经阻滞能为上肢创伤患者提供更完善的麻醉。
Objective This study tested whether ultrasound-guided interscalene brachial plexus block and selective nerve blocks in the axilla can produce a better anesthesia for the upper limb surgery. Methods Eighty patients scheduled for one site surgery in an upper limb were randomly assigned to receive ultrasound-guided brachial plexus block by a single approach (interscalene,supraclavicular,infraclavicular or axillary approach ) according to the type of surgery and different pattern of distribution of anesthesia of each approach (group S, n=40) or a combination of the interscalene approach with selective nerve blocks in the axilla (group C, n=40). Performance time, sensory and motor blockade scores of the nerves that innervate the uppper limb, incidences of patients needing for rescue anesthesia and incidences of adverse events were recorded. Results Sensory and motor blockage scores were significantly higher in group C than in group S (p = 0.000, p = 0.002, respectively). Performance time was longer in group C than in group S (9.0 ± 2.5 min vs 6.5 ± 2.0 min, p = 0.001). There were no statistical differences in the incidences of patients needing for rescue anesthesia and in the incidences of adverse events between the two groups. Conclusion Ultrasound-guided interscalene brachial plexus block and selective nerve blocks in the axilla can produce better anesthesia for the patients in an upper limb surgery.
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