目的：比较锁骨下入路与腋路入路臂丛神经阻滞的临床麻醉效果。方法拟行前臂及手外科择期手术患者60例，采用随机数字法分为两组各30例。神经刺激器定位下分别于锁骨中点下入路（A 组）和腋路（B 组）行臂丛神经阻滞。 A组定位上肢远端运动反应，B 组定位正中神经和肌皮神经运动反应后注入局麻药。比较两组患者神经阻滞成功率、阻滞起效时间、运动阻滞以及并发症情况。结果A 组患者均在锁骨下入路行阻滞下完成手术，B 组5例无法定位出目标运动反应，在超声辅助下继续完成麻醉。 B 组麻醉起效时间短于 A 组，5支神经痛觉阻滞率 A 组高于 B 组（P ＜0．05）。 A 组有1例、B 组有4例误入血管。结论改良的锁骨下臂丛神经阻滞成功率更高，并发症少，阻滞效果更完善。%Objective To compare the anesthetic effects between infraclavicular approaches and axillary approaches in brachi -al plexus block.Methods Sixty patients scheduled for forearm or hand surgery were randomly assigned to receive infraclavicular (Group A,n =30)and axillary(Group B,n =30)brachial plexus block located by the nerve stimulator .In the group A,distal motor response(flexion or extension of the wrist or fingers )was defined as the target motor response .In the group B,median nerve and muscu-locutaneous nerve were as the target nerve .The success rate of forearm pain block ,the block onset time and complications were recor -ded.Results All cases in the group A completed surgery under the infraclavicular brachial plexus block .In the group B,five patients can't elicit the target response and then complete anesthesia with ultrasound assistance .The block success rate of all five nerves was higher in the group A than that in the group B .However,the onset time was faster in the group B than that in the group A .There were four cases of vascular puncture in the group B and one in the group A .Conclusion The modified infraclavicular brachial plexus block has a higher success rate,fewer complications,and better blocking effect .
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