126史生醴堂袭击2OO6年2月第26卷第2期ChinJAnesthesial，February2006，Vol26，No．2上肢手术病人超声引导锁骨上臂丛神经阻滞的效果’李挺吴道珠徐旭仲黄品同【摘要】目的探讨上肢手术病人超声引导锁骨上臂丛神经阻滞的效果。方法拟在锁骨上臂丛神经阻滞下行上肢手术病人120例，ASAI—m级，随机分为3组(t／．=40)：超声引导组(u组)、神经刺激器组(N组)、传统方法组(T组)。局麻药为0．75％罗哌卡因与2％利多卡因等容量混合液。剂量为0．4ml·kg一。记录肌皮神经、桡神经、正中神经、尺神经阻滞的起效时间，并评价其阻滞完善率；评定手术全程的麻醉效果(优、良、差)，记录并发症。结果U组4根神经阻滞完善率均接近100％(P>0．05)，N组和T组尺神经的阻滞完善率均低于肌皮神经和桡神经(P<0．05)。与T组比较，U组和N组正中神经阻滞完善率均较高，麻醉优良率较高，起效时间均较短(P<0．05或0．01)。与N组比较，U组尺神经阻滞完善率和麻醉优等率较高，起效时间较短(P<0．01)。T组穿刺过程中有3例误入血管，3组均无严重并发症。结论上肢手术病人超声引导锁骨上臂丛神经阻滞较神经刺激器辅助和传统方法下的阻滞效果更好，起效时间更短，在临床上具有推广应用价值。【关键词】超声检查，介入性；臂丛；神经传导阻滞Ultrasound-guidedsupraclavicularbrachialplexusblockforupperextremityoperationL，Ting．WUDao-zhu，XUXu．zhong，eta1．DepartmentofAnesthesiology，SecondAfiliatedHospital，WenzhouMedicalCollege，Wenzhou325027。ina【Abstract】ObjectiveTocomparetheefectivenessofsupraclavicularbrachialplexusblockguidedbyultrasoundwiththatguidedbynervestimulatororanatomicallandmarks．MethodsOnehundredandtwentyASAI-mpatients(81male，39female)aged16-62yrsweighing40—75kgscheduledforupperextremityoperationunderbrachialplexusblockviasupraelavieularapproachwererandomizedinto3groups(n=40each)：IngroupUblockwasguidedbyultrasound；ingroupNnervestimulatorwasusedtolocatethebrachialplexusandingroupTblockwasperformedinthetraditionalwaybasedonanatomicallandmarks．Amixtureofequalvolumesof0．75％ropivacaineand2％lidocaine(0．4rrd‘kg)wasinjectedinthe3groups．Theonsetandintensityofsensoryblockofmusculocutaneous，median，radialandulnarnervesweremeasuredandanalgesiawasrated8sexcellent，efectiveandfailure．ResultsTherateofsatisfactoryblockofulnarnervewassignificantlylowerthanthatofmusculocutaneousandradialnervesingroupNandT(P<0．05)．WhileingroupUtherewasnosignificantdiferenceintheintensityofblockofthethreenervesandtheblockofulnarnervewassatisfactory．TherateofsatisfactorymediannerveblockwassignificantlyhiglleringroupUandNthaningroupT．Theonsettimeoftheblockofthe4nerveswaslongestingroupTandshortestingroupU(P<0．O1)．Theefectiveratewas100％ingroupU，92．5％ingroupNand47．5％ingroupT(P<0．05)．Excellentblock(surgerywasaccomplishedwithoutsupplementarydrugs)wasachievedin95．5％ofthepatientsingroupU；in70％ingroupNand47．5％ingroupT．Inadvertentarterialpunctureoccurredin3patients．Therewasnomajorcomplicationproducedbytheblockinallthe3groups．ConclusionUltrasound—guidedsupraclavicularbrachialplexusblockforoperationsonupperextremityissignificantlybetterthantheothertwotechniquesintermsofonsettimeandsuccessrateoftheblock．【Keywords】Uhrasonography，interventional；Braehialplexus；Nerveblock作者单位：325027，温州医学院附属第二医院麻醉科(李挺、徐旭仲)，本院超声科(吴道珠、黄品同)通信作者：徐旭仲，325027，温州医学院附属第二医院麻醉科·局部麻醉·维普资讯http://www.cqvip.com中华麻醉学杂志2OO6年2月第26卷第2期ChinJAnesthesiol，February2006，Vol26—,N—o．2臂丛神经阻滞是一项传统麻醉技术，广泛用于上肢手术，其成功的关键在于...
