超声引导下腋路臂丛神经阻滞麻醉效果观察

摘要

Objective To observe the effect of ultrasound guided axillary brachial plexus block anesthesia. Methods Selected 100 cases of ASA Ⅰ~Ⅱ grade during may 2014 to March 2016 March, normal physique, 18~55 year-old male, scheduled for unilateral upper extremity surgery. Ultrasound guided axillary approach brachial plexus block. Ultrasound anatomical image contrast injection. Observed and recorded the location of the brachial plexus sheath, manipulation, the effect of anesthesia, incidence of adverse reactions. Local anesthetic dosage: 0. 5% ropivacaine 30 ml. Ultrasound equipment: color Doppler ultrasound system Mindray. Results From the skin to the brachial plexus sheath ( average):On the edge:0.406 cm, lower edge:1.662 cm. Average operating time:5 minutes and 05 seconds;93% of operating when used within 4 to 6 minutes. Anesthetic effect: excellent 91%( 91/100 ) , good 9%( 9/100 ) , poor 0%, invalid 0 %. Adverse reaction statistics:Puncture site hematoma in 1 case; Bezold-Jarisch reflection one case. No pneumothorax, no local anesthetic toxic reactions, no nerve damage, no serious reaction tourniquet. Conclusions Axillary brachial plexus block guided by ultrasound can be applied to the surgery of the hand of the upper limb, after the injection, at least 16 minutes to wait. If they can not wait, in a safe range, the use of large dose ( concentration) of local anesthetics and ( or) additional local anesthesia is necessary.%目的：观察超声引导下腋路臂丛神经阻滞的麻醉效果。方法选择2014年5月至2016年3月期间100例ASAⅠ~Ⅱ级、体格正常、18~55岁男性拟行单侧上肢手部手术患者。在超声引导下行腋路臂丛神经阻滞。对比注药前的超声解剖图像,观察记录臂丛神经鞘的位置,观察记录操作用时,麻醉阻滞效果,不良反应发生率。局麻药用量：0.5％罗哌卡因30 ml。超声设备：迈瑞彩色多普勒超声系统。结果臂丛神经鞘到皮肤的距离(平均值)：上缘0.406 cm,下缘1.662 cm。操作平均用时5分05秒,93％的操作用时在4~6 min内。麻醉效果：优91％(91/100),良9％(9/100),差0％,无效0％,有效率为100％(100/100)。不良反应：穿刺部位血肿1例；贝贾氏反射1例。无气胸、无局麻药中毒反应、无神经损伤、无严重止血带反应。结论超声引导下腋路臂丛神经阻滞适用于单侧上肢手部的手术,注药结束后,至少需等待16 min,如不能等待,在安全范围内,使用较大剂量(浓度)的局麻药和(或)追加局部麻醉是有必要的。