黄文斌+禤建锋+冯卫荣+廖高庆

[摘要] 目的 观察超声引导技术在上肢手术患者神经阻滞中的应用效果。 方法 选择2012年1月～2013年12月在我院择期行上肢手术患者200例，随机分为两组各100例，A组使用传统的解剖定位法，B组采用超声引导技术定位，局麻药均使用1%利多卡因+0.375%罗哌卡因 +地塞米松10mg的混合液。比较两组神经阻滞的效果：麻醉起效时间、麻醉成功率、麻醉药使用量、并发症的发生率。 结果 麻醉操作完成时间：B组比A组短 ；神经阻滞起效时间：B组比A组长 ；B组麻醉效果好，优秀率达到97.00%，优良率达到100.00%，A组麻醉效果一般，优秀率47.00%，优良率91.00%；B组不良反应发生率为2.00%，A组高达9.00%；A、B两组比较差异均有统计学意义（P<0.05）。而麻醉持续时间差异无统计学意义（P>0.05）。 结论 超声引导技术运用到上肢神经阻滞中能提高麻醉效果，减少麻醉药物用量，减少并发症与不良反应。

[关键词] 超声引导技术；神经阻滞；上肢

[中图分类号] R614[文献标识码] B[文章编号] 1673-9701（2014）18-0068-03

Effectof upper limb nerve block by ultrasound-guidedtechnology

HUANG WenbinXUAN Jianfeng FENG Weirong LIAO Gaoqing

Department of Anesthesiology,the Peoples Hospital of Lianzhou City in Guangdong Province, Lianzhou 513400, China

[Abstract] Objective To observe the clinical effect of ultrasound-guided technology in the operation of upper limb in patients with nerve block. Methods Two huandred patients had be performed upper limb operation in our hospital form Jan2012 to Dec 2013 were randomly divided into two groups, 100 cases of each group, group A who was guided by traditional anatomical method;group B who was guided by ultrasound-guided positioning technolog, 1% Lignocaine + 0.375% Ropivacaine + 10 mg Dexamethasone were injected in two groups. Comparison of the effect of two groups nerve block: the onset time of anesthesia, success rate, the amount, complications. Results Anesthesia operation completion time, group B was shorter than group A(TA=7.7±1.9min, TB=4.6±1.4min);Nerve block work time, group B was longer than groupA(TA=19.4±3.4min, TB=10.7±2.3min);group B anesthesia effect was good, with excellence rate reached 97% and fine rate was 100.00%；group A anesthesia effect was general, excellence rate reached 47.00%,fine rate was 91.00%;group B adverse reactions incidence was 2.00%, group A was up to 9.00%;compared the above group A and B related datas of difference was statistically significant (P<0.05).The duration of anesthesia(TA=417.5±98.7min, TB=406.3±79.1min), the more similar between two groups had no statistical significance (P>0.05). Conclusion Ultrasound-guided technology was applied to the upper limb brachial plexus block, which could enhance the effect of nesthesia, reduce the dosage of anesthetic drug ,complications and adverse reaction.

[Key words] Ultrasound-guidedtechnology; Nerve block; Upper limb

上肢手术常用的局部麻醉方法是采用上肢神经阻滞，具有局部镇痛完全、患者手术中意识清醒、并发症及不良反应少、患者感觉效果好等优点，而要取得麻醉效果优秀的关键在于如何准确进行上肢神经定位。传统方法是以人体的解剖标志进行穿刺定位，但是其成功率较低，且易损伤神经、血管，引起严重的并发症和不良反应，因此对于解剖标志不清或手术不合作的患者神经阻滞失败率可高达20%[1-3]。然而超声引导技术作为一种新的介入超声技术，对于上肢神经准确定位具有关键性的作用。……