摘要
目的:观察肌间沟和腋路臂丛联合神经阻滞术在复杂上肢手术中的临床效果、安全性和可行性。方法:80例上肢骨科疾患拟行手术治疗患者,按单一臂丛或联合臂丛随机分为:肌间沟和腋径路联合组(50例,I+A组)、肌间沟径路组(15例,I组)和腋径路组(15例,A组)。I+A组采用肌间沟和腋路臂丛联合神经阻滞术。局麻药均采用1%lidocaiine+0.25%Levobupivacaine混合液。分别观察三组局部麻醉药用量、麻醉效果、并发症以及术中镇痛药(Pethidine)与镇静药(Midazolam)的用量。结果:I+A组和A组局麻药使用量明显多于I组(P<0.01);I+A组优良率达100.0%,显著高于I组(80.0%)和A组(70%)(均P<0.01);轻度局麻药中毒:I+A组(8.0%)和A组(6.7%)显著高于与I组(均P<0.05);与A组和I组比较,I+A组阻滞完成时间增加(20～25)min,但均不需使用镇痛药和镇静药。结论:肌间沟和腋路臂丛联合神经阻滞术麻醉效果确切,有较重要临床应用价值,但应防治局麻药中毒。
Objective：To observe the clinical efficacy,safety and feasibility of combined interscalene and axillary brachial plexus block. Methods：80 patients scheduled for upper limb surgery were randomly divided into three groups under combined interscalene and axi!lary brachial plexus block （Group I＋A,n=50）,interscalene brachial plexus block （GrOup I,n=15）,and axillary brachial plexus block （Group A,n=15）. All the patients received 1%lidocaiine with 0.25% levobupivacaine for local anesthesia.We observed the local anesthetics dose,anesthetic effect, complications and doses of analgesic （Pethidine） and sedatives （Midazolam） used during surgery.Results：Compred with Group I,up I＋A and Group A used significantly more local anesthetics （P〈O 01）.The fine anesthetic efficacy rate in Group I＋A is 100%,whiCh is significantly higher than Group I （80.0%,p〈0.01） and Group A （70%,P〈0.01 ）.The incidence of mild toxic reaction is 8.0% in Group I＋A and 6.7% in Group A,both of which are higher than Group I （P〈0.01）.Compared with Group A and Group I, the time to perform the block was 20 to 25 minutes longer in Group I＋A,hut the analgesics and sedatives were not needed during surgery, Conclusion：Our study suggests that combined interscalene and axillary braehial plexus block has a confirmative anesthetic efficacy with important clinical significance.However,we should pay attention to the local anesthetic toxic reaction.
出处
《中国医药导刊》
2010年第10期1665-1666,共2页
Chinese Journal of Medicinal Guide
关键词
臂从神经阻滞
肌间沟径路
腋径路
上肢手术
Brachial plexus block
Axillary brachial plexus block
Interscalene brachial plexus block
Upper limb surgery
