改良法锁骨上路臂丛神经阻滞应用的临床观察.DOCVIP

临床医学论文-改良法锁骨上路臂丛神经阻滞应用的临床观察 ???????????????? 作者：曹殿青 姚业兴 杨光平 【关键词】? 改良 ??? 摘要：目的：探讨一种新的并发症少、操作简单、效果佳的锁骨上路臂丛神经阻滞方法。方法：随机选择上肢手术患者50例，随机分为两组：实验组采用改良法锁骨上路臂丛神经阻滞，对照组采用传统法。注入0.33%罗哌卡因+0.66%利多卡因20ml，实验组采用20#动静脉留置针穿刺给药。成功标志：神经异感或触及第一肋或套针置入顺利，采用视觉模拟量表（VAS）和语言模拟量表（VRS）进行疼痛评估。结果：实验组首次成功率100%，而对照组仅为80.2%。两组患者镇痛方面没有明显差异。不良反应方面：对照组误穿血管3例，实验组0例；对照组气胸1例，实验组0例。结论：改良法锁骨上路臂丛神经阻滞技术同传统法相比，操作简便易行、作用确切、并发症少，临床可安全使用。 ??? 关键词：锁骨上路；臂丛神经阻滞；改良；罗哌卡因 ??? Clinical use of Modified Supra Clavicular Branchial Nerve Block ??????? Abstract： Objective： To observe the clinical effect of modified supra-clavicular branchial nerve block. Method： Fifty ASA Ⅰ～Ⅱpatients undergoing elective supra limb surgery were randomly divided into two groups: Patients were anesthetized with modified supra-clavicular branchial nerve block in catheter 20# in experimental group and traditional supra-clavicular branchial nerve block in control group with compounds of ropi- vacaine and lidocaine. Analgesia degree was evaluated by VAS and VRS. Result： Achievement rate of first manipulation in experiment group (100%) was higher than that in control group (80.2%) significantly (P0.05).There was no significant difference between two groups in analgesia. There was 3 cases with complication of misinjection into vascular and 1 case with complication of pneumothorax in control group, there was no such complication in experiment group. Conclusion： Compared with traditional method, modified supra-clavicular branchial nerve block has such advantages as easy and feasible manipulation, exact action and fewer complication, it deserves to be used widely. ??? Key words：Supraclavicular;Branchial nerve lcok;Modify;Ropivacaine ??? 上肢手术一般多采用臂丛神经阻滞，其中以锁骨上路阻滞最为完全。然而由于解剖因素，传统方法容易发生气胸而且操作成功率低。本研究旨在寻求一种简单易行、并发症少的锁骨上路臂丛神经阻滞方法。 ??? 1资料与方法 ??? 1.1病人资料：50例行择期上肢手术患者，年龄20～50岁，体重56～76kg，ASAⅠ～Ⅱ级，心肺、肝肾功能正常，无周围神经系统疾病，均为首次手术。随机分为两组：实验组采用改良法，对照组采用传统法。 ??? 1.2麻醉方法：两组患者均于术前30min常规肌注鲁米那100mg+阿托品0.5mg。传统法：采用锁骨中点上方2～3cm，向前、向下、向内进针（向脚），有异感或触及第一肋给药［1］；改良法：锁骨中点上方2～3cm，向前