摘要
目的臂丛麻醉时将麻醉药注入臂丛鞘内有时不能得到满意的麻醉效果,因此,有必要深入研究臂丛神经阻滞效果与臂丛鞘的关系。文中应用CT观察局麻药在臂丛鞘内的分布与扩散,探讨肌间沟臂丛神经阻滞的效果。方法 60例拟行上肢手术的患者,随机分为非异感(non-paresthesia,NPAR)组和神经刺激器定位(peripheral nerve stimulator,PNS)2组,每组30例,评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,每组随机选择8例行CT检查,扫描范围自C3至T3平面,并行注药侧的冠、矢状面CT重组成像,测量臂丛上、中、下干周围局麻药物的扩散范围。结果局麻药局限性分布于臂丛鞘内,肌间沟水平为完整的鞘样结构,其下方有明显的分隔,局麻药的分布范围在臂丛上干、中干2组间无明显差异,下干PNS组麻醉药分布高于NPAR组(P<0.05)。2组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分均无统计学意义差异;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分NPAR组明显高于PNS组(P<0.05)。结论臂丛鞘是多腔结构,局麻药物注射的位置和深度直接影响阻滞效果,偏向尺侧的手术采用PNS定位效果更好。
Objective To observe the distribution of local anesthetics by means of CT and analyze the effects of interscalene brachial plexus block.Methods Sixty patients scheduled for upper extremity operations were randomized to two groups（n=30 in each group）： group NPAR（non-paresthesia）,and group PNS（peripheral nerve stimulator）.The extent of sensory and motor blockade of each innervated region was assessed by scale scores,the anesthetic effects of surgical field was observed and recorded as well.CT scan was performed from C4 to T3 to reconstruct,at sagittal and coronal planes,the interscalene injected with anesthetics（8 cases in each group,randomly）,and to measure the range of the distribution of local anesthetics.Results The diffusion of local anesthetic was confined in brachial plexus sheath,the sheath was intact at interscalene level,the septa was seen in other place.There was no significant difference in the range of the distribution of local anesthetics in superior or median trunks of brachial plexus between the two groups,but the range in inferior trunks was significantly greater in group PNS than in group NPAR（P0.05）.There was no significant difference in sensory or motor scale scores of axillary nerve,musculocutaneous nerve,median nerve and musculospiral nerve.The sensory scale scores of cutaneous antebrachii medialis nerve and cubital nerve and the motor scores of cubital nerve were significantly higher in group NPAR than in group PNS（P0.01）.Conclusion The brachial plexus sheath is a multicompartmented structure,the location and length of injection affects directly the effects of the brachial plexus block,in ulnar operations PNS is more effective.
出处
《医学研究生学报》
CAS
2010年第9期956-959,共4页
Journal of Medical Postgraduates
关键词
肌间沟
臂丛阻滞
体层摄影术
X线计算机
Interscalene
Brachial plexus block
Tomography
X-ray computed
