摘要
目的评价超声引导近端筋膜间闭孔神经阻滞的效果。方法择期行尿道膀胱肿瘤电切术患者70例，性别不限，年龄43～82岁，体重指数18．0～30．5kg／m2，ASA分级I或Ⅱ级，采用随机数字表法，将其分为2组（n=35）：远端筋膜间闭孔神经阻滞组（R组）和近端筋膜间闭孔神经阻滞组（P组）。R组在超声引导下于远端筋膜间（短收肌外侧和深面）闭孔神经后支和前支分别注射0．375％罗哌卡因7．5ml。P组在超声引导下于近端筋膜间（耻骨肌与闭孔外肌间）闭孔神经注射0．375％罗哌卡因15．0ml。分别于注药前（基础状态）、注药后5、10和15min时测定阻滞侧大腿内收肌肌力，然后于L3，4间隙行脊椎-硬膜外联合麻醉。肌力下降程度超过50％为阻滞成功。记录闭孔神经阻滞操作时间。计算注药后各时点大腿内收肌肌力下降百分比和注药后15min时闭孔神经阻滞成功情况。术毕对闭孔神经阻滞临床效果进行分级，并计算临床有效率（0级和1级为临床有效）。结果与R组比较，P组操作时间缩短，阻滞成功率升高，注药后10和15min时大腿内收肌肌力下降百分比升高，临床效果分级更优（P〈0．05）。2组临床有效率比较差异无统计学意义（P〉0．05）。结论与超声引导远端筋膜间闭孔神经阻滞相比，超声引导近端筋膜间闭孔神经阻滞操作更简便快捷，阻滞成功率更高，临床阻滞效果更好。
Objective To evaluate the efficacy of ultrasound-guided obturator nerve block using proximal interfascial technique. Methods Seventy ASA physical status I or H patients of both sexes, aged 43-82 yr, with body mass index of 18.0-30.5 kg/m2, scheduled for elective trans-urethral resection of bladder tumor, were randomly divided into 2 groups （n = 35 each） using a random number table： remote interfascial technique group （group R） and proximal interfascial technique group （group P）. In group R, interfascial injections at 2 planes, lateral and deep to the adductor brevis muscle, were carried out with 0.375% ropivacaine 7.5 ml to block each obturator nerve branch separately. In group P, 0.375% ropivacaine 15.0 ml was injected under ultrasound guidance at the interfascial plane inferior to the superior pubic ramus （ between the pectineus and obturator externus）. The strength of thigh adduction was measured before injection （baseline） and at 5, 10, and 15 min after injection. Then combined spinal-epidural anesthesia was performed at L3.4 interspace. The 50% strength reduction indicated a successful block. The block performance time was recorded. The success rate of block at 15 min after injection was calculated. It was considered clinically effective when obvious muscle twitching interfering with the surgical procedure did not appear. The clinical outcome was assessed, and the effective rate of clinical outcome was calculated. Results Compared with group R, the block performance time was significantly shortened, the success rate of block, strength reduction at 10 and 15 min after injection, and clinical outcome were increased in group P. There were no significant differences in the effective rate of clinical outcome. Conclusion Compared with remote interfascial technique, ultrasound-guided obturator nerve block using proximal interfascial technique provides easier and rapid procedure, higher success rate of block and better clinical outcome of block.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第7期840-843,共4页
Chinese Journal of Anesthesiology
