柳春玲

摘 要 目的：探討B超联合神经刺激仪行臂丛神经阻滞的临床效果。方法：收集2015年6月至2016年6月择期行上肢手术患者60例，按照定位方式不同分为观察组33例和对照组27例。对照组采用B超引导下臂丛神经阻滞，观察组采用B超联合神经刺激仪引导下臂丛神经阻滞，比较两组患者麻醉操作时间、臂丛神经痛觉阻滞起效总时间、阻滞完善总时间以及各臂丛神经痛觉阻滞完善率。结果：观察组麻醉操作时间、阻滞起效总时间、阻滞完善总时间分别为（3.49±0.62）min、（20.88±2.32）min和（52.97±3.08）min，对照组分别为（4.73±0.68）min、（31.05±2.47）min和（78.96±3.77）min，组间差异有统计学意义（P<0.05）。观察组正中神经痛觉阻滞完善率为100.00%（33/33），显著高于对照组的88.89%（24/27，P<0.05）。两组桡神经、尺神经、肌皮神经、前臂内侧皮神经痛觉阻滞完善率和麻醉优良率差异无统计学意义（P>0.05）。但观察组麻醉优秀率为96.97%（32/33）显著高于对照组的81.48%（22/27，P<0.05）。结论：B超联合神经刺激仪行臂丛神经阻滞效果优于单纯B超引导下臂丛神经阻滞，值得推荐。

关键词 麻醉；臂丛神经阻滞；B超；神经刺激仪

中图分类号：R614.4 文献标志码：A 文章编号：1006-1533（2017）14-0032-02

Clinical effect of B ultrasound combined with nerve stimulator on brachial plexus block

LIU Chunling（Department of Anesthesiology of Traditional Chinese Medicine Hospital of Xinyu， Xinyu 338000， Jiangxi Province， China）

ABSTRACT Objective： To investigate the clinical effect of B ultrasound combined with nerve stimulator on brachial plexus block. Methods： According to the different positioning methods 60 patients undergoing upper limb surgery from June 2015 to June 2016 were divided into an observation group with 33 cases and a control group with 27 cases. The control group took the B ultrasound guidance for brachial plexus block， and the observation group adopted B ultrasound combined with nerve stimulator guiding brachial plexus block， and the operation time， anesthesia effect of brachial plexus block pain time， complete block time and the total brachial plexus block pain improvement rate of patients in the two groups were compared. Results： The operation time， the total time of onset of anesthesia， and the total time of improvement were （3.49±0.62） min， （20.88±2.32） min and （52.97±3.08） min in the observation group， respectively and those of the control group were （4.73±0.68） min， （31.05±2.47） min and （78.96±3.77） min， respectively， and the differences were statistically significant （P<0.05）. In the observation group， the perfect rate of median nerve block was 100%（33/33）， which was significantly higher than that of the control group 88.89% （24/27， P<0.05）. There were no significant differences between the two groups in radial nerve， ulnar nerve， musculocutaneous nerve， medial forearm cutaneous nerve block and the excellent rate of anesthesia （P>0.05）. But the excellent rate of the observation group was 96.97%（32/33）， which was significantly higher than that of the control group 81.48% （22/27， P<0.05）. Conclusion： The effect of B ultrasound combined with nerve stimulator on brachial plexus block is better than that of B ultrasound guidance for brachial plexus block， which is worthy of recommendation.

KEY WORDS anesthesia； brachial plexus block； B ultrasound； nerve stimulator

臂丛神经阻滞麻醉是手、前臂、上臂及肩部等上肢手术的常用麻醉方式，临床上对于臂丛神经阻滞麻醉的报道较多，常见的入路方式是肌间沟入路[1]。由于臂丛神经具有结构复杂、周围重要组织多等特点，因此找准穿刺位置是麻醉操作的重要环节[2]。本文报道将B超与神经刺激仪联合实施臂丛神经阻滞效果十分满意，并对其临床优势进行分析，以期为相关研究提供参考。

1 资料与方法

1.1 一般资料

收集2015年6月至2016年6月新余市中医院择期行上肢手术患者60例，符合美国麻醉师协会（ASA）分级Ⅰ～Ⅱ级，麻醉入路方式为肌间沟入路，按照定位方式不同分为观察组33例和对照组27例。观察组中男性18例，女性15例，年龄11～82岁，平均（45.65±6.88）岁；对照组中男性15例，女性12例，年龄11～82岁，平均（45.70±6.56）岁。……