吴瑞华　蔡晓斌　王传光

[摘要] 目的 探討超声引导上臂中段神经阻滞对前臂改良穿支皮瓣V-Y治疗患者术后肢端运动功能恢复的影响。方法 选择2015年2月～2017年8月在丽水市中心医院和遂昌县人民医院择期行前臂改良穿支皮瓣V-Y治疗患者84例，采用随机数字表法将其分为A、B两组（n=42）。A组采用两点法行超声引导上臂神经阻滞；B组采用一点法超声引导锁骨上臂丛神经阻滞。术中监测并记录两组患者在不同神经支配区域药物阻滞起效时间、感觉、功能恢复时间、肩和肘关节运动恢复时间以及术后患者满意度、不良反应等。 结果 两组患者术中、术后均未发生严重不良反应，但在注药后30 min患者VAS评分、注药后超声定位神经阻滞成功率以及术后患者满意度评价方面，A组与B组比较差异有统计学意义（P<0.05）。两组患者在超声定位神经阻滞穿刺操作后起效时间、术后患者肘关节及肩关节运动功能恢复时间方面，A组与B组比较差异有统计学意义（P<0.05）；但两组患者在感觉功能恢复时间上比较差异无统计学意义（P>0.05）。 结论 超声引导上臂神经阻滞能较大限度保留肩关节、肘并节的运动功能，提高患者的满意度。

[关键词] 超声；上臂；神经阻滞；穿支皮瓣；运动功能

[中图分类号] R614 [文献标识码] A [文章编号] 1673-9701（2018）12-0023-05

Effect of ultrasound-guided upper arm middle segment nerve block on the recovery of limb motor function of patients receiving V-Y modified forearm perforator flap

WU Ruihua1 CAI Xiaobin2 WANG Chuan'guang3 FU Qunwen1 WU Zhenhua3 WU Lingfeng2

1.Room of Ultrasound B， Suichang County Peoples Hospital in Zhejiang Province， Suichang 323300， China； 2.Department of Hand Reconstruction Surgery， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China； 3.Department of Anesthesiology， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the effect of ultrasound-guided upper arm middle segment nerve block on the recovery of postoperative limb motor function of patients receiving V-Y modified forearm perforator flap. Methods From February 2015 to August 2017， 84 patients receiving selective V-Y modified forearm perforator flap who were treated in Lishui Central Hospital and Suichang County People's Hospital were selected. The patients were divided into two groups according to the random number table（n=42）. Group A was given two-point method for ultrasound-guided upper arm nerve block； group B was given one-point method for ultrasound-guided supraclavicular brachial plexus block. Drug block onset time， senses， and functional recovery time in different areas of nerves， shoulder and elbow motor recovery time， as well as postoperative patient satisfaction and adverse reactions in the two groups of patients were intraoperatively monitored and recorded. Results There were no serious adverse reactions in both groups during operation and after operation. However， there were statistically significant differences in VAS scores 30 min after injection， the success rate of ultrasonic localization nerve block after injection， and evaluation of postoperative patients' satisfaction between group A and group B（P<0.05）. There were statistically significant differences in onset time after puncture of ultrasonic localization nerve block， and the recovery time of elbow joint and shoulder joint function after operation between group A and group B（P<0.05）； however， there was no statistically significant difference between the two groups in the recovery time of sensory function（P>0.05）. Conclusion Ultrasound-guided upper arm nerve block can retain the motor function of the shoulder joint and elbow joint to a greater extent and improve patients' satisfaction.

[Key words] Ultrasound； Upper arm； Nerve block； Perforator flap； Motor function

近年来，在治疗骨创伤性疾病过程中通过采用自体游离皮瓣移植术，为患者的术后康复发挥了重要的作用[1]，手术中常以神经阻滞麻醉用于改良穿支皮瓣V-Y手术患者，但该方法不仅阻滞上肢感觉神经[2]，同时还会阻滞上肢的运动功能，导致术后患者的活动和手功能恢复时间延长，延长了患者的住院时间，降低了患者的满意度，甚至还可因麻醉效果不良而导致术后患者疼痛不适，以及术后移植部位发生皮瓣缺氧、缺血等问题[3，4]。……