王磊 宋薇薇

[摘要] 目的 探討超声引导与传统解剖定位行臂丛神经阻滞的麻醉效果。方法 方便选取2017年1月—2018年1月间在该院进行上肢手术的患者150例，ASAⅠ-Ⅲ级，随机分为两组，每组75例，超声引导组（U组）与传统方法组（T组）。U组采用超导定位下的臂丛神经阻滞，T组采用传统解剖定位臂丛神经阻滞。观察并记录两组神经阻滞麻醉起效时间、操作完成时间以及不良反应和并发症发生率。结果 U组患者的麻醉起效时间、操作完成时间分别为（3.19±0.21）min，（3.59±0.16）min，T组分别为（5.98±0.11）min，（4.98±0.26）min，U组显著低于T组，差异有统计学意义（t=111.650、43.194，P<0.05），U组患者并发症发生率、不良反应发生率分别为0.00%、1.33%，T组分别为5.33%、9.33%，U组显著低于T组，两组比较，差异有统计学意义（χ2=4.109、4.754，P<0.05）。 结论 超声引导与传统解剖定位行臂丛神经阻滞相比较，超声引导臂丛神经阻滞操作时间更短、麻醉起效时间更短，麻醉效果更加完善，并具有较高的安全性，值得在临床大力推广。

[关键词] 超声引导；传统解剖定位；臂丛神经阻滞；麻醉效果

[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742（2018）08（a）-0187-03

Comparison of Anesthetic Effects of Brachial Plexus Block with Ultrasound Guidance and Conventional Anatomic Positioning

WANG Lei1， SONG Wei-wei2

1.Department of Anesthesiology， Dongying Second People's Hospital， Dongying， Shandong Province， 257335 China； 2.ECG， Dongying Second People's Hospital， Dongying， Shandong Province， 257335 China

[Abstract] Objective To investigate the anesthetic effects of brachial plexus block with ultrasound guidance and traditional anatomical positioning. Methods A total of 150 patients undergoing upper extremity surgery in the hospital from January 2017 to January 2018 were convenient selected and classified as ASA I-III and randomly divided into two groups （n=75）. Ultrasound-guided group （U group） and traditional methods Group （T group）. In the U group， the brachial plexus block was performed with superconducting localization. In the T group， the brachial plexus block was positioned with traditional anatomy. Observe and record the onset time， operation completion time， incidence of adverse reactions and complications in the two groups of nerve block anesthesia. Results The onset time and operation completion time of group A were（3.19±0.21）min and （3.59±0.16）min， respectively. The T group was （5.98±0.11）min and （4.98±0.26）min respectively. The U group was significantly lower than the T group. The difference was significant. Statistical significance （t=111.650， 43.194， P<0.05）. Incidence of complications and incidence of adverse reactions were 0.00% and 1.33% in group U， and 5.33% in group T， respectively.9.33%， U group was significantly lower than T group， the difference between the two groups was statistically significant （χ2=4.109， 4.754， P<0.05）. Conclusion Ultrasound-guided brachial plexus block compared with traditional anatomical positioning， ultrasound-guided brachial plexus block more short operation time， shorter onset of anesthesia， better anesthetic effect， and higher safety， it is worth clinical promotion.

[Key words] Ultrasound guidance； Traditional anatomical location； Brachial plexus block； Anesthetic effect

臂丛神经阻滞是一项传统麻醉技术，常用于上肢手术[1]。传统的臂丛神经阻滞，是通过对患者颈部的肌肉、骨骼辨识，进而定位穿刺点进行麻醉穿刺[2]。但这种方式是盲探操作，需寻找针尖触探到神经时的异感，并需要患者准确描述，患者主观体验较为痛苦，如找不到异感，则有可能会进行多次穿刺，增加了气胸、神经损伤、血管损伤等的几率。且临床常遇到患者肥胖、局部外伤、解剖变异等情况，增加了传统定位的难度，降低了阻滞成功率。总体来说，具有较高的神经阻滞不全发生率[3]。随着医疗技术的不断发展，超声引导技术在临床中得到广泛应用，超声技术使得神经阻滞进入了可视化时代。国内很多学者[4]认为，使用这种方式进行神经阻滞，可准确定位目标神经，实时引导穿刺，缩短操作时间，提高穿刺准确度，降低患者痛苦。……