超声引导下神经阻滞在小儿上肢手术麻醉中的应用.docVIP

超声引导下神经阻滞在小儿上肢手术麻醉中的应用 　　[摘要] 目的 探讨超声引导下神经阻滞在小儿上肢手术麻醉中的应用。 方法 选取ASAⅠ级或Ⅱ级择期拟行上肢手术的患儿40例，随机均分为解剖定位组和超声引导组，丙泊酚靶控输注麻醉后待患儿睫毛反射消失和对言语指令无反应时，分别在常规定位法和超声引导下行肌间沟臂丛阻滞和腋路臂丛阻滞，术中根据情况吸入不同浓度的七氟醚维持麻醉深度，观察两组的神经阻滞操作时间、阻滞效果、七氟醚用量和相关并发症，并评价其安全性和临床麻醉效果。 结果 超声引导组完成神经阻滞操作时间明显短于解剖定位组，神经阻滞效果明显优于解剖定位组，七氟醚用量明显少于解剖定位组，麻醉后血液损伤并发症发生率明显低于解剖定位组，差异有统计学意义（P0.05）。 结论 超声引导下肌间沟臂丛神经联合腋路臂丛神经阻滞能很好地满足小儿上肢手术的麻醉需要，极具优势，安全性高，与传统解剖定位方法相比，超声引导下臂丛神经阻滞可提高麻醉质量，减少全麻药用量，降低相关并发症的发生率，提高疗效，值得临床广泛推广应用。 　　[关键词] 超声引导；神经阻滞；小儿上肢手术；麻醉 　　[中图分类号] R614.4[文献标识码] A[文章编号] 1674-4721（2014）06（b）-0093-03 　　 　　Clinical application of ultrasound guided nerve block anesthesia in pediatric upper extremity anesthesia 　　ZHU Cai-yan TAN Yu-ming WU Yu-si LUO Nan-bo LIU Yuan-yuan BAI Tao-yang 　　Department of Anesthesiology,the Second People′s Hospital of Shenzhen City,Shenzhen 518000,China 　　[Abstract] Objective To investigate the application of ultrasound guided nerve block in pediatric upper extremity anesthesia. Methods 40 cases of patients with ASA Ⅰ or Ⅱ undergoing selective operation were selected,and were randomly divided into anatomical location group (group NS) and ultrasound guided group (group VS),After target-controlled infusion of propofol anesthesia when children eyelash reflex disappeared and unresponsive to verbal commands,interscalene brachial plexus block and axillary brachial plexus block was carried out by the conventional method and ultrasound guided positioning in anatomical location group and ultrasound guided group respectively.Different concentrations of sevoflurane was inhaled to maintain the depth of anesthesia.The nerve block anesthesia operation time,anesthesia effect,the amount of sevoflurane,and complications in two groups was observed respectively. Results The nerve block anesthesia operation time of ultrasound guided group was shorter than that of anatomical location group,anesthesia effect was better than that of anatomical location group,the amount of sevoflurane was less than that of anatomical