关于超声引导下一点法或三点法颈丛阻滞的效果研究
投稿时间:2014-05-14  修订日期:2014-05-16  点此下载全文
引用本文:杨林译,谢红,沈江,卜晓萱,高操,范圣登.关于超声引导下一点法或三点法颈丛阻滞的效果研究[J].医学研究杂志,2015,44(2):39-42
DOI: 10.3969/j.issn.1673-548X.2015.02.011
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作者单位E-mail
杨林译 213000 常州, 苏州大学附属第三医院麻醉科  
谢红 苏州大学附属第二医院麻醉科  
沈江 213000 常州, 苏州大学附属第三医院麻醉科  
卜晓萱 213000 常州, 苏州大学附属第三医院麻醉科  
高操 213000 常州, 苏州大学附属第三医院麻醉科  
范圣登 213000 常州, 苏州大学附属第三医院麻醉科 gjzszg@hotmail.com 
基金项目:国家自然科学基金资助项目(青年项目)(81302047)
中文摘要:目的 比较超声引导下比较超声引导下两种颈神经丛阻滞(颈丛阻滞)方法即C4横突一点法和C2、C3、C4横突三点法的麻醉效果及并发症的发生情况。方法 择期拟行单侧甲状腺次全切除术患者60例, 性别不限, ASA Ⅰ或Ⅱ级, 随机分为2组(n=30):两组均作双侧颈浅丛阻滞及术侧颈深丛阻滞。颈浅丛阻滞均为在超声引导下将局麻药注射在胸锁乳突肌中点后缘下方。C4横突一点法组(A组)在超声引导下在C4横突处注射局麻药9ml;C2、C3、C4横突三点法组(B组)超声引导下于C2、C3、C4横突处各注射局麻药3ml。记录起效时间、麻醉优良率、阻滞前和阻滞后5、10、15、20、30min的生命体征, 并观察并发症的发生情况。结果 超声引导C2、C3、C4横突三点法颈深丛阻滞和C4横突一点法颈深丛阻滞进行对比, 三点法组的耳大神经分布区域起效时间短于一点法组, 而锁骨上神经分布区域起效时间长于一点法组(P < 0.05)。三点法组的深部麻醉优秀率较一点法更为完善(P < 0.05), 两种方法成功率比较, 差异无统计学意义。一点法A组出现1例Horner's综合征, 两组均无膈神经阻滞、喉返神经阻滞、误入血管、局部麻醉药中毒。结论 超声可以作为颈深丛阻滞的定位方法并可进行实时引导颈丛神经阻滞。通过超声准确定位, 进行C2、C3、C4横突三点法和C4横突一点法两种颈深丛阻滞方法的麻醉效果比较发现, 三点法颈深丛阻滞比一点法更为完善, 术中患者循环更为稳定, 且并发症发生例数较少, 但差异无统计学意义。
中文关键词:超声检查  颈神经丛  神经传导阻滞  并发症
 
Efficacy of Ultrasound-guided Cervical Plexus Block by C4 Single-injection Technique or C2, C3, C4 Three-injection Technique
Abstract:Objective To compare the efficacy of ultrasound-guided cervical plexus block by C4 single-injection technique and C2, C3, C4 three-injection technique. Methods Sixty ASA Ⅰ or Ⅱ patients scheduled for subtotal thyroidectomy were randomly divided into 2 groups(n=30 each group). All the patients were given bilateral superficial cervical plexus block.In group A, single injection with 9ml local anesthetic was given around the tip of C4 vertebral transverse process by ultrasound guidance.In group B, three injections with 3 ml local anesthetic were manipulated around the tip of C2, C3, C4 cervical vertebral transverse process by ultrasound guidance. The duration of analgesia and the onset time of the area innervate by lesser occipital nerve, great auricular nerve, transverse nerve and supraclavicular nerve were measured. The efficacy of analgesia was evaluated at four levels: excellent, good, bad and failure. The physical sign on 5min, 10min, 15min, 20min, 30min and complications after block was measured. Results C2, C3, C4 three-injection technique cervical plexus block was more effective than C4 single-injection technique and caused fewer complications. But there was no difference in the success rate between these two methods (P < 0.05). Conclusion Ultrasound can guide the cervical plexus block. C2, C3, C4 three-point-technique has higher success rate and fewer complications than C4 one-point-technique by precise ultrasound guidance. Precise C2, C3, C4 three-injection is a promising technique in clinic work.
keywords:Ultrasonography  Cervical plexus  Nerve block  Complication
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