经腋路贯穿动脉两点注药法臂丛阻滞临床观察.docVIP

经腋路贯穿动脉两点注药法臂丛阻滞临床观察【摘要】目的 评价经腋路贯穿动脉两点注药法臂丛阻滞的麻醉效果。方法 采用经腋路贯穿动脉两点注药法臂丛阻滞对40例行上肢前臂和手部手术的患者实施阻滞麻醉，观察镇痛及阻滞效果，起效时间及局麻药中毒，神经损伤，血管刺伤和血肿等并发症。结果 阻滞起效时间为（8.5±3.0）min，神经阻滞效果评级达Ⅰ级的35例，占87.5%，Ⅱ级3例，占7.5%，Ⅲ级1例，占2.5%，Ⅳ级1例，占2.5%。有3例出现误穿血管，但无血肿，无一例出现中毒反应，神经损伤等并发症。结论 经腋路贯穿动脉两点注药法臂丛阻滞定位准确性高，可使局麻药沿腋动脉两侧扩散，能大大提高阻滞成功率。 【关键词】经腋路贯穿动脉 臂丛阻滞 麻醉 临床观察 中图分类号：R614文献标识码：A文章编号：1005-0515（2011）1-024-02 The axillary artery runs through the two injection methods of clinical observation of brachial plexus block LI Guozhen (Pi County People’s Hospital of Sichuan Pixian, 611730) 【Abstract】Objective To evaluate the axillary artery runs through the two injection methods brachial plexus block anesthesia. Methods The axillary artery runs through the two injection brachial plexus block method in 40 routine upper forearm and hand surgery for patients with anesthesia, analgesia and block effects observed, onset time and local anesthetic toxicity, nerve injury, vascular puncture, and hematoma complications. Results The block onset time (8.5±3.0) min, nerve block effect rating of grade Ⅰ, 35 cases, accounting for 87.5%, Ⅱ grade 3 patients, accounting for 7.5%, Ⅲ level 1 cases, accounting for 2.5%, Ⅳ Level 1 cases, accounting for 2.5%. 3 patients had mistakenly wearing blood vessels, but no hematoma, with no toxic reaction occurs, nerve injury. Conclusion The axillary artery runs through the two injection method with high accuracy positioning brachial plexus block, local anesthetic can spread along both sides of the axillary artery, can greatly improve the block success rate. 【Key words】after axillary artery running through clinical observation of brachial plexus block anesthesia 腋路臂丛神经阻滞具有操作简便、副作用少的优点，是临床上常用的麻醉方法之一。传统腋路臂丛神经阻滞是在腋动脉搏动最高点处进行穿刺，以刺破腋血管神经鞘膜和穿刺针随动脉搏动而摆动作为穿刺成功的标志，寻找异感较困难，两种指标很难确定针尖是否已刺人动脉鞘内，且为一点注药，常常会导致阻滞不全。笔者经长期临床实践，认为贯穿腋动脉腋路臂丛阻滞两点注药法有利于提高穿刺成功率和阻滞效果，现将方法介绍如下。 1 资料与方法 1.1 一般资料 自愿接受臂丛神经阻滞，拟行上肢前臂和手部手术的患者4０例，年龄18-65岁，ASAⅠ-Ⅱ级，体重48-75kg,男23例，女17例，所有患者均签署麻醉知情同意书。术前常规检查出凝血时间，血常规及心电图