【摘要】 目的:通过高频超声引导锁骨上、下臂丛神经阻滞的麻醉效果,来评价锁骨上、下臂丛神经阻滞的价值,旨在探讨一种新的外周神经阻滞方法。方法:选择上肢前臂及手部、血管造瘘手术患者120例,随机分成超声引导锁骨上(SCB)和锁骨下(ICB)二组,每组各60例,各组均在超声引导下完成阻滞,两组测定麻醉操作时间,分别记录腋神经、上臂内侧皮神经、前臂外侧皮神经、前臂内侧皮神经、尺神经、正中神经、桡神经的起效时间,麻醉持续时间和麻醉并发症,并评定麻醉效果。结果:高频超声能成功地引导到达靶神经,并能清晰地显示局麻药的扩散。SCB组和ICB组的麻醉操作时间分别为(4.5±3.2)min,(3.9±1.6)min,两组无显著性差异(P>0.05);SCB组的前臂内侧皮神经、尺神经、桡神经的起效时间分别为(8.3±3.1)min、(7.1±2.8)min和(3.8±4.1)min,ICB组分别为(4.1±2.0)min、(3.6±1.7)min和(8.5±1.8)min,SCB的前臂内侧皮神经、尺神经的起效时间较ICB组长,而桡神经的起效时间较短(P<0.05);两组麻醉完善率为100%。SUB组麻醉有效率86%,INF组有效率80%,两组无显著性差异(P>0.05)。SCB的组Horner`s综合征发生率为16%,ICB无并发症。结论:高频超声能清楚地显示臂丛神经,其能监测锁骨上、下臂丛神经阻滞是一种可行的区域麻醉方法,尤其对锁骨下臂丛神经阻滞更为安全有效。更多还原

【Abstract】 Objective:Observing the anaesthesia quality of supraclavicular and infraclavicular brachial plexus block by ultrasound-guided,we evaluated the value of the brachial plexus block by mean of high-resolution sonography in order to explore the new approach of peripheral nerve block.Methods:One hundred and twenty patients scheduled for elective surgery of forearm and hand or Arteriovenous fistulization of forearm were randomly divided into two groups,i.e.,supraclavicular(SCB) group and infraclavicular(ICB) group,with 60 subjects in each group.The performance time was recorded.The onset time and the block execution time of axillary nerve,median cutaneous nerve of arm,lateral antebrachial cutaneous nerve,median antebrachial cutaneous nerve,ulnar nerve,median nerve,and radial nerve were measured respectively,and then the block quality was evaluated.Results:High-resolution ultrasound could successfully guided brachial plexus block and clearly displayed the local anesthetic distributing around never.The performance times were(4.5±3.2) min in SCB group and(3.9±1.6) min in ICB group(P>0.05).The onset times of median antebrachial cutaneous,ulnar nerves and radial nervers in SCB group were(8.3±3.1) min,(7.1±2.8) min and(3.8±4.1) min,and these were(4.1±2.0) min,(3.6±1.7) min,and(8.5±1.8) min in the ICB.The onset times of the antebrachial cutaneous and ulnar nerves in the ICB group were significantly longer than these in SCB group(P<0.05),and the radial nerve was shorter(P<0.05).The complete success rates of block in SCB and ICB group were respectively 86% and 80%,respectively(P>0.05).The incidence of complication for Horner syndrome in the SCB group was 16%,but there was no complication in ICB group.Conclusion:High-resolution sonography can clearly display the brachial plexus.Supraclavicular and infraclavicular brachial plexus block by ultrasound-guided are feasible technique in regional anaesthesia.Ultrasound-guided infracla vicular brachial plexus block is much safer and is deserved to apply in clinic practice.更多还原