吴铁 陈家趁 周辉

[摘要]目的探究神經刺激仪引导下肌间沟连续镇痛联合腋路臂丛神经阻滞在上肢手术患者的应用效果。方法选择2018年4月至2021年4月于阳江市阳东区人民医院开展上肢手术患者100例为研究对象，采用随机数字表法分为对照组（ n=50）与研究组（ n=50），对照组采用传统异感定位神经阻滞方案，研究组采用神经刺激仪引导下肌间沟连续镇痛联合腋路臂丛神经阻滞方案。比较两组阻滞操作时间、穿刺次数、阻滞起效时间、手术时间与麻醉效果，记录两组术后不良反应情况。结果研究组阻滞操作时间为（9.07±2.11）min，短于对照组的（11.34±2.37）min，穿刺次数为（1.25±0.20）次，少于对照组的（3.17±0.86）次，阻滞起效时间为（11.09±2.09）min，短于对照组的（13.44±2.56）min，差异有统计学意义（ P <0.05）;两组手术时间差异无统计学意义（ P >0.05）;研究组麻醉效果优良率为100.00%（50/50），高于对照组的86.00%（43/50），研究组不良反应发生率为8.00%（4/50），低于对照组的28.00%（14/50），差异有统计学意义（ P <0.05）。结论神经刺激仪引导下肌间沟连续镇痛联合腋路臂丛神经阻滞在上肢手术患者的应用具有阻滞操作时间短、穿刺次数少、阻滞起效时间短、麻醉效果好、不良反应少等优点，值得临床应用与推广。

[关键词]神经刺激仪;肌间沟;镇痛;臂丛神经阻滞;麻醉;上肢手术

[中图分类号] R614 [文献标识码] A  [文章编号]2095-0616（2021）22-0093-04

Effect of applying continuous analgesia of intermuscular groove combined with axillary brachial plexus block under the guidance of nerve stimulator to the patients undergoing upper limb surgery

WU  Tie   CHEN  Jiachen   ZHOU  Hui

Department of Anesthesiology， People's Hospital of Yangdong District of Yangjiang City， Guangdong， Yangjiang 529500， China

[Abstract] Objective To explore the effect of applying continuous analgesia of intermuscular groove combined with axillary brachial plexus block under the guidance of nerve stimulator to the patients undergoing upper limb surgery. Methods A total of 100 patients undergoing upper limb surgery in People's Hospital of Yangdong District of Yangjiang City from April 2018 to April 2021 were selected as the research subjects. They were divided into the control group （n=50） and the study group （n=50） according to random number table method. The control group was treated with traditional allosensory localization nerve block scheme， while the study group was treated with the scheme of continuous analgesia of intermuscular groove combined with axillary brachial plexus block under the guidance of nerve stimulator. The block operation time， puncture times， block onset time， operation time and anesthesia effect were compared between the two groups， and the postoperative adverse reactions （ARs） of the two groups were recorded. Results The block operation time of the study group， （9.07±2.11） min， was shorter than （11.34±2.37） min of the control group. The puncture times of the study group， （1.25±0.20） times， were fewer than （3.17±0.86） times of the control group. The block onset time， （11.09±2.09） min， was shorter than the （13.44±2.56） min of the control group， and all the differences were statistically significant （P <0.05）. There was no statistically significant difference in operation time between the two groups （P >0.05）. The excellent and good rate of anesthesia effect in the study group was 100.00%（50/50）， higher than the 86.00%（43/50） in the control group， and the incidence of ARs in the study group was 8.00%（4/50）， lower than the 28.00%（14/50） in the control group， with statistically significant differences （P <0.05）. Conclusion The application of continuous analgesia of intermuscular groove combined with axillary brachial plexus block under the guidance of nerve stimulator to the patients undergoing upper limb surgery has theadvantages of shorter block operation time， fewer puncture times， shorter block onset time， better anesthesia effect and fewer ARs， etc. It is worthy of clinical application and promotion.

[Key words] Nerve stimulator; Intermuscular groove; Analgesia; Brachial plexus block; Anesthesia; Upper limb surgery

臂丛神经阻滞在临床上被广泛用于肩关节以下的上肢手术中，是骨科上肢手术麻醉方案的首选[1]，该麻醉方案具有体表解剖标志明显，操作简单、对患者呼吸抑制影响小、保留患者意识等优点[2-3]。臂丛神经阻滞当前主要有肌间沟及腋路阻滞两种方案，各有优点，但肌间沟入路仍然存在尺侧阻滞不全，腋路存在桡侧阻滞不全的情况[4]，因此，单一阻滞方法难以满足手术麻醉效果，常需给予辅助用药，部分患者甚至需更改为全身麻醉，增加麻醉风险与患者身心负担。……