摘要
目的探讨超声引导下臂丛神经阻滞鞘膜内、外2种注射方法对膈肌活动度及呼吸抑制的影响。方法右上肢骨折内固定术后拟行内固定取出手术患者60例,随机分为鞘膜外组(超声引导下鞘膜外臂丛神经阻滞麻醉)和鞘膜内组(超声引导下鞘膜内臂丛神经阻滞麻醉)各30例;采用M型超声分别对平静呼吸和深呼吸状态下,神经阻滞前、注射药物后15、30 min膈肌活动度进行测量并记录;应用Easy-One肺功能仪检测2组神经阻滞前及注射药物后15、30 min第1秒用力呼气量(forced expiratory volume in one second, FEV1)、用力肺活量(forced vital capacity, FVC),比较2组麻醉效果,神经阻滞前后膈肌活动度、肺功能及并发症情况。结果鞘膜外组感觉阻滞起效时间[(18.2±2.1)min]和运动阻滞起效时间[(16.5±2.3)min]长于鞘膜内组[(11.6±1.9)、(9.3±2.1)min](P<0.05),感觉阻滞持续时间[(932.3±155.0)min]和运动阻滞持续时间[(976.3±155.6)min)]与鞘膜内组[(1 011.2±149.3)、(1 106.2±150.3)min]比较差异无统计学意义(P>0.05);2组患者神经阻滞前、阻滞后15、30 min FEV1/FVC比较差异无统计学意义(P>0.05);平静呼吸和用力呼吸状态下,鞘膜外组阻滞前、阻滞后15、30 min时膈肌活动度比较差异无统计学意义(P>0.05),鞘膜内组阻滞后30 min膈肌活动度[(1.5±0.5)、(4.1±0.9)cm]低于阻滞前[(2.2±0.4)、(5.5±0.8)cm]和鞘膜外组阻滞后30 min[(1.8±0.6)、(4.8±0.8)cm](P<0.05);鞘膜内组阻滞后30 min膈肌部分及完全麻痹(43.33%、26.67%)、霍纳综合征(40.00%)、声音嘶哑(36.67%)、上肢感觉及运动异常(33.33%)发生率均高于鞘膜外组(20.00%、6.67%,26.67%、6.67%、3.33%)(P<0.05)。结论与鞘膜内注射相比,超声引导下鞘膜外臂丛神经阻滞在提供有效镇痛的同时,可降低膈肌麻痹的发生率,减少对患者呼吸功能的影响。
Objective To investigate the effects of intrathecal and extrathecal injection for ultrasound-guided brachial plexus block on diaphragmatic activity and respiratory depression. Methods Sixty patients with fracture of right upper limb scheduled to removal of internal fixation device were randomly divided into 30 patients receiving ultrasound-guided extrathecal brachial plexus block(extrathecal group) and 30 patients receiving ultrasound-guided intrathecal brachial plexus block(intrathecal group). M-mode ultrasound was used to measure and record diaphragmatic activity under quiet breathing and deep breathing before, as well as 15 and 30 min after brachial plexus block, respectively. The Easy-One pulmonary function instrument was used to detect the forced expiratory volume in one second(FEV1) and forced vital capacity(FVC) in two groups before, as well as 15 and 30 min after brachial plexus block, respectively. The anesthetic effect, diaphragmatic activity before and after block, lung function and complications were compared between two groups. Results The sensory block time((18.2±2.1) min) and motion block time((16.5±2.3) min) in extrathecal group were longer than those in intrathecal group((11.6±1.9),(9.3±2.1)min)(P<0.05).There were no significant differences in sensory block duration((932.3±155.0)min vs.(1 011.2±149.3)min)and motor block duration((976.3±155.6)min vs.(1 106.2±150.3)min)between extrathecal group and intrathecal group(P>0.05).FEV1/FVC showed no significant differences before,as well as 15 and 30 min after brachial plexus block between two groups(P>0.05).Both under quiet breathing and deep breathing,the diaphragmatic activities showed no significant differences before,as well as 15 and 30 min after brachial plexus block in extrathecal group(P>0.05),and were lower 30 min after block((1.5±0.5),(4.1±0.9)cm)than those before block((2.2±0.4),(5.5±0.8)cm)in intrathecal group(P<0.05)and 30 min after block in extrathecal group((1.8±0.6),(4.8±0.8)cm)(P<0.05).The incidences of partial and complete diaphragmatic paralysis,Horner syndrome,hoarseness and upper limb sensory/motor abnormalities were significantly higher in intrathecal group(43.33%,26.67%,40.00%,36.67%,33.33%)than those in extrathecal group(20.00%,6.67%,26.67%,6.67%,3.33%)(P<0.05).Conclusion Compared with intrathecal injection,ultrasound-guided extrathecal brachial plexus block can reduce the incidence of diaphragmatic paralysis and impact on respiratory function during analgesia.
作者
李甜甜
景红霞
肖彬
郑光美
薛锐
王家镜
胡培
LI Tiantian;JING Hongxia;XIAO Bin;ZHENG Guangmei;XUE Rui;WANG Jiajing;HU Pei(Imaging Center, Shiyan People's Hospital, People's Hospital Affiliated to Hubei University of Medicine , Shiyan 442000 , China;Department of Anesthesiology , Shiyan People's Hospital,People's Hospital Affiliated to Hubei University of Medicine , Shiyan 442000, China)
出处
《中华实用诊断与治疗杂志》
2019年第10期1011-1014,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
湖北省卫生健康科研基金资助项目(WJ2019F046)
湖北省十堰市科技局引导性科研项目(19Y58)
关键词
膈肌麻痹
M型超声
臂丛神经阻滞
鞘膜外
diaphragmatic paralysis
M-mode ultrasound
brachial plexus block
extrathecal
