摘要
目的比较超声引导定位与神经刺激器定位行肌间沟臂丛神经阻滞用于肥胖患者的效果及其安全性。方法选择拟行上肢手术、体质指数(BMI)≥30 kg/m2的患者40例,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级,随机均分为超声引导定位组(U组)和神经刺激器定位组(N组)。两组均给予0.5%罗哌卡因。记录两组完成操作所需时间、感觉阻滞起效时间、感觉阻滞效果和局部麻醉药的用量,评定手术全程的麻醉效果,并记录相关并发症的发生情况。结果 U组完成操作所需时间为(6.2±1.7)min,显著短于N组的(15.7±2.4)min(P<0.05)。U组局部麻醉药用量为(17.8±1.3)mL,显著少于N组的(27.6±3.5)mL(P<0.05)。U组臂丛7支神经的感觉阻滞起效时间均显著快于N组(P值均<0.05)。U组尺神经、正中神经、前臂内侧皮神经感觉阻滞完善率分别为92%、80%、85%,均显著高于N组的60%、45%、50%(P值均<0.05)。U组未出现并发症,N组有4例患者出现与神经阻滞相关的并发症。结论肥胖患者在超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,局部麻醉药的用量少,并发症少,值得临床推广应用。
Objective To compare the efficacies and safeties of ultrasound-guided interscaline brachial plexus block（U group） and nerve stimulator-guided interscaline brachial plexus block（N group） in obese patients.Methods Forty patients with body mass index（BMI） 30 kg/m2,American society of anesthesiologists（ASA） class Ⅰ or Ⅱ,who were scheduled for upper extremity operation,were evenly randomized into group U and group N.Both groups were given 0.5% ropivacaine.The time required to complete the procedures,sensory block onset time,sensory block effect,and the amount of local anesthetics were observed to assess the anesthesia effects throughout surgery,and the related complications were also observed.Results The time needed to complete the procedure in U group was significantly shorter than that in N group（[6.2±1.7] min vs.[15.7±2.4] min,P0.05）.The U group needed significantly less anesthetics compared with N group（[17.8±1.3] mL vs.[27.6±3.5] mL,P0.05）.Faster onset time of sensory block was observed in U group in 7 branches of interscaline brachial plexus compared with that in N group（P0.05）.The rates of adequate anesthesia of ulnar nerve,median nerve,and cutaneous nerve in the U group（92%,80%,and 85%） were significantly higher than those in the N group（60%,45% and 50%,P 0.05）.No complications were found in the U group,and N group had 4 cases who developed nerve blocked-related complications.Conclusion Ultrasound guided interscalene brachial plexus block is time-saving in obese patients,and has a rapid block onset and satisfactory effect;meanwhile,it needs less anesthetics and has fewer complications,making it worth popularizing in clinic.
出处
《上海医学》
CAS
CSCD
北大核心
2011年第8期609-612,共4页
Shanghai Medical Journal
关键词
超声
臂丛神经阻滞
肥胖
Ultrasonagraphy
Brachial plexus nerve block
Obesity
