上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (5): 510-.doi: 10.3969/j.issn.1674-8115.2018.05.005

• 论著·临床研究 • 上一篇    下一篇

神经外周间隙生理盐水扩张法在腋路臂丛阻滞中的应用

李于鑫，徐杨，胡倩，崔德荣   

  1. 上海交通大学附属第六人民医院麻醉科，上海 200233
  • 出版日期:2018-05-28 发布日期:2018-05-28
  • 通讯作者: 崔德荣，电子信箱：Cuishuning118@163.com。
  • 作者简介:李于鑫（1992—），男，住院医师，学士；电子信箱： yuxinlee121@sina.com。
  • 基金资助:
    国家自然科学基金（81671879）；上海市卫生和计划生育委员会基金（201740118）；上海交通大学医工交叉研究基金（YG2016MS17）

Application of perineural space expansionnormal saline in axillary brachial plexus block

LI Yu-xin, XU Yang, HU Qian, CUI De-rong   

  1. Department of Anesthesia, Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2018-05-28 Published:2018-05-28
  • Supported by:
    National Natural Science Foundation of China, 81671879; Shanghai Health and Family Planning Commission Fund, 201740118; Interdisciplinary Program of Shanghai Jiao Tong University, YG2016MS17

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摘要： 目的 ·比较超声引导下神经外周间隙生理盐水扩张联合血管旁注射法（ perineural space expansion-perivascular technique，PSEPV）与传统血管旁注射法（ perivascular technique，PV）在腋路臂丛阻滞中的临床效果。方法 ·采用随机、对照、双盲的方法，将 60例急诊手部外伤患者分为 2组，分别为 PSE-PV组和 PV组，每组 30例，麻醉方法均为超声引导下腋路臂丛阻滞。 PSE-PV组在腋动脉正上方 12点方位注射 5 mL生理盐水将目标神经与腋动脉及周围组织分离后再注射 15 mL 0.5%罗哌卡因； PV组在腋动脉 12点方位直接注射 20 mL 0.5%罗哌卡因。记录操作后 30 min感觉和运动阻滞评分、操作时间、阻滞成功率、不良反应发生情况。结果 · PSEPV组的感觉、运动阻滞评分分别为 1.7±0.3和 1.6±0.3，PV组分别为 1.8±0.4和 1.6±0.3，差异均无统计学意义（均 P>0.05）。 PSE-PV组操作时间为 (4.0±1.3) min，略高于 PV组的 (3.9±1.1) min，差异无统计学意义（ P>0.05）。2组患者的神经阻滞成功率均为 100%。仅有 PV组 1例患者发生轻度局部麻醉药中毒反应。结论 ·超声引导下神经外周间隙生理盐水扩张法可以减少腋路臂丛阻滞局部麻醉药用量，麻醉效果与传统方法相当，未增加神经阻滞操作时间和不良反应。

关键词: 腋路臂丛阻滞, 神经外周间隙扩张, 超声, 局部麻醉

Abstract:

Objective · To compare the clinical effect of ultrasound-guided perineural space expansionnormal saline combined with perivascular technique (PSE-PV) with traditional perivascular technique in axillary brachial plexus block (PV). Methods · A randomized, controlled, and double blind study was performed. Sixty patients arranged for emergency hand surgery were allocated to 2 groups, i.e. PSE-PV group and PV group, with 30 cases in each group receiving ultrasound-guided axillary brachial plexus block. For PSE-PV group, injection was carried out at the 12 oclock position using 5 mL of normal saline firstly to expand the perineural space followed15 mL of 0.5% ropivacaine at the same position. The patients of PV group got their injections of 20 mL of 0.5% ropivacaine at the direction of 12 oclock of axillary artery. The sensory and motor blockade assessment 30 min after drug injection, performance time, success rate, and adverse events were recorded. Results · The sensory and motor blockade scores were 1.7±0.3 and 1.6±0.3 in PSE-PV group, and 1.8±0.4 and 1.6±0.3, respectively in PV group without significant differences (P>0.05). The performance time of PSE-PV group was (4.0±1.3) min, a little longer than that of PV group, but the difference was not statistically significant (P>0.05). The success rates of nerve block reached 100% in both groups. Only 1 case in PV group reacted to the local anesthetics. Conclusion · Ultrasound-guided perineural space expansionnormal saline reduces dosage of local anesthetics in axillary brachial plexus block, which has similar anesthetic effect, performance time and adverse effect with traditional perivascular method.

Key words: axillary brachial plexus block, perineural space expansion, ultrasound, local anesthesia

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