特制神经阻滞导管针在臂丛阻滞及镇痛中的应用

摘要

目的 探索使用国产特制非刺激型外周神经阻滞留置导管针(专利号:200820152063.9和200920166821.7)在上肢手术及术后镇痛的可行性.方法 前瞻性择期或急诊行上肢手术成年患者62例,ASAⅠ～Ⅲ,使用特制的非刺激型外周神经阻滞留置导管针,采用改良肌间沟法或腋鞘置管法行连续臂丛神经阻滞,术后通过留置导管使用0.2％罗哌卡因镇痛.观察患者麻醉效果、不良反应、术后镇痛和镇静效果、恶心呕吐发生率、穿刺置管部位有否感染、神经损伤、导管平均留置时间及患者满意度等.结果 使用此留置导管针麻醉成功率是96.8％；腋鞘置管法麻醉操作一次成功率85.2％,改良肌间沟置管法78.8％；严重毒性反应发生率分别为3.7％和3 0％；均无注射部位血肿、Horner氏综合征、声嘶及呼吸困难等；术后0、12、24、48 h VAS镇痛评分:静止时镇痛有效率100％,活动时91.7％；Ramesay镇静评分平均0.1分；术后恶心呕吐发生率8.3％,患者满意度平均9.1分,均未出现穿刺置管部位感染、神经损伤及呼吸抑制；导管留置平均时间30.5 h；镇痛结束拔除导管后患肢无感觉麻目等异常症状.结论 使用此特制非刺激型外周神经阻滞留置导管针行连续臂丛神经阻滞,术中麻醉效果确切,术后镇痛效果满意,并发症少,安全可靠,值得临床推广应用.%Objective To evaluate the application of a specially designed non-irritating needle with indwelling cannula in brachial plexus blockage and postoperative analgesia. Methods Sixty two patients undergoing upper-limb surgery received modified interscalene or axillary brachial plexus blockage and followed by postoperative patient-controlled analgesia (PC A) with local analgesics; a specially designed non-irritating needle with an external indwelling cannula was used in the procedure. The anesthetic effect, acute or chronic complications, postoperative analgesic effect and satisfaction of patients were evaluated. Results The success rate for anesthesia was 96: 8%. The single attempt placement the external indwelling cannula was 85.2 % with axillary brachial plexus block, and 78. 8% with modified interscalene brachial plexus block. The incidence rate of severe intoxication was 3.7% with axillary and 3. 0% with modified interscalene block. There was no injection site hematoma,Homer's syndrome, hoarseness and dyspnea. The 0,12,24,48 h postoperative analgesic VAS score in resting state was 100% and that in active state was 91. 7%. Ramsay sedation scores were 2. 2 on average. The incident rate of nausea and vomit was 8.3%; the satisfaction of patients was 9.1 on a 0 -10 scale. The duration of external indwelling cannula was 30. 5 h on average, there was no infection, nerve injury or respiratory depression occurred during the period of indwelling catheter. Conclusion Brachial plexus blockage using a non-irritating needle with an external indwelling cannula has distinct intraoperative anesthetic benefits and provides an excellent postoperative analgesic outcome with safety.