【2017年整理】超声引导下肌间沟臂丛在肩关脱位手法复位术中的效果.doc

超声引导下肌间沟臂丛在肩关节脱位手法复位术中的效果 【摘要】 目的 超声引导下肌间沟臂丛在肩关节脱位手法复位术中的效果。方法：急诊拟行肩关节脱位手法复位术80例，均行肌间沟臂丛神经阻滞，按随机数字表法分为超声组和传统异感组各40例，分别于超声引导下（A组）与异感法（B组）来寻找臂丛神经位置并阻滞。观察两组臂丛神经阻滞起效时间，麻醉效果及不良反应发生情况。结果 A组臂丛神经阻滞时间为(9.0士4.2)分钟，B组为(17.7士5.9)分钟，两组差异有统计学意义（P0.05）；A组阻滞成功率95.0%，B组为80.0%，A组明显高于B组两组麻醉效果相比较，两组差异有统计学意义（P0.05）；Ａ组不良反应发生率为5.0%，Ｂ组为25.0％，两组相比差异有统计学意义（P0.05)。 Abstract:Objective?Ultrasound-guided brachial plexus between the shoulder dislocation manipulative reduction surgery results.Methods: Emergency undergoing shoulder dislocation manipulative reduction surgery, 80 cases underwent interscalene brachial plexus block, were randomly divided into groups and traditional ultrasound paresthesia group 40 cases, respectively, under ultrasound guidance (A group) and paresthesia method (group B) to find the location and brachial plexus block. Brachial plexus block were observed onset time of anesthetic effects and adverse events. Results A group brachial plexus block time (9.0 Disabled 4.2) minutes in group B (17.7 Disabled 5.9) minutes, the difference was statistically significant (P 0.05); A group block success rate of 95.0%, B group was 80.0%, a group and B group was significantly higher than the effect of anesthesia compared, the difference was statistically significant (P 0.05); a group of adverse reactions was 5.0%, group B 25.0%, respectively compared to the difference was statistically significant (P 0.05). 【关键词 】 超声引导；臂丛神经阻滞； 肩关节脱位 臂丛是由第5—8颈神经前支和第1胸神经前支的大部分纤维组成，经斜角肌间隙走出，行于锁骨下动脉后上方，经锁骨后方进入腋窝 [1]。由于肩关节的深部组织结构由C5~C6脊神经支配，所以肩部手术可在肌间沟臂丛神经阻滞下完成。肩关节脱位患者由于肩部疼痛，传统臂丛神经阻滞异感法操作一定困难，不良反应较多。笔者对急诊肩关节脱位手法复位术中行超声引导下行臂丛神经阻滞，取得良好效果，现报道如下： 1 资料与方法 1.1 临床资料 选取在福建省晋江市中医院从2015年1月-2016年7月份80例肌间沟臂丛行肩关节脱位手法复位术患者，随机分为A组（40例）和B组（40例）。ASA Ⅰ～Ⅱ级成年患者，男50例，女30例，年龄18～60岁，体重45～75 kg。两组患者年龄、性别、体重、病种及手术时间等差异均无统计学意义(P0.05)。行急诊肩关节脱位手法复位术，术前无镇痛药、麻醉药过敏或成瘾；无长期酗酒；无神经病史无严重的呼吸、循环系统疾病及严重的肝、肾疾病。 1.2 麻醉方法 术前30 min肌内注射苯巴比妥钠0.1 g，入手术室后，开放静脉，给予0.05mg/kg咪达唑仑镇静，监护下进行组织操作。取平卧位，头偏向对侧，手臂紧贴身体，由专人负责臂丛阻滞操作，A组患者使用美国Sonosite公