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蛙状颈丛神经阻滞麻醉的临床应用研究（重新投稿）
The study of frog-like cervical plexus block anesthesia in clinic

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DOI:
作者:
段宏伟
DUAN Hongwei
作者单位:
浦东新区南汇中心医院 复旦大学附属华山医院南汇分院
Branch of Nanhui of Huashan Hospital, Pudong New Area, Shanghai 201300, China)
关键词:
颈丛神经阻滞；麻醉；方法；蛙状；
Cervical plexus never block; Anesthesia ; Method; Frog-like
摘要:
【摘要】 目的 探讨“蛙状”颈丛神经阻滞法临床应用的可行性和安全性。 方法 择期行甲状腺肿块手术的患者80例，随机分为两组，实验组 (I组)：采用“蛙状”颈丛神经阻滞法，对照组（II组）：采用C4横突一针阻滞法，每组各40例。局麻药均为0.25%罗哌卡因。由麻醉医师和手术医师共同评价阻滞效果；监测抬头肌力；有无并发症发生等。记录麻醉前（T0）、麻醉后10min（T1）、切皮时（T2）、分离瘤体时（T3）、手术结束时（T4）等5个时点的血压、心率、脉搏血氧饱和度。结果 与麻醉前比较，BP、HR于组I切皮、分离瘤体时，相对比较平稳，无显著性差异（p>0.05）；于组II差异有显著性（p<0.05）；组间比较，BP、HR于切皮、分离瘤体时，差异有显著性（p<0.05）。阻滞优良率，实验组为95%，对照组为80%，两组比较差异有显著性（p<0.05）。两组脉搏血氧饱和度均大于95%，抬头肌力无变化，均无并发症发生。结论“蛙状”颈丛神经阻滞法是一种较好的麻醉方法，值得临床推广应用。
【Abstract】 Objective: To investigate the method of the feasibility and safety in bilateral superficial cervical plexus never block anesthesia under the skin of neck in clinic. Methods: Eighty ASA I or II adult patients undergoing excision of thyroid gland were randomly divided into two groups. group I (n=40): the method of bilateral superficial cervical plexus block was directly to inject local anesthetic drug under the skin of neck and formed two bulge just as the shape as a noisy frog bulged in the neck (a frog-method), the sick side superficial cervical plexus were blocked with11ml and the other with 15ml of 0.25% ropivacaine. Group II (n=40): the method of cervical plexus block anesthesia in C4 transverse process (one-point method), bilateral superficial cervical plexus were blocked with 6-8ml of 0.25% ropivacaine ; Both groups deep the cervical plexus were blocked with 4ml of 0.25% ropivacaine. The efficacy, muscle strength of neck and complications of cervical plexus block were assessed by anesthetist and surgeon. Blood pressure (BP), heart rate (HR), and pulse oxygen saturation were monitored before block anesthesia, after block anesthesia 10, incision of skin, thyroid gland operation, after operation. Results: Compared with before anesthesia and between two groups, BP、HR were significantly increased in incision of skin and thyroid gland operation in group II(p<0.05), there were no significantly difference in group I (p>0.05). The rate of excellent or good results was 95% in Group I (38/40) and 80% in group II(32/40), there were significantly difference(p<0.05). In two group, there were no significantly change in pulse oxygen saturation and muscle strength of neck (p>0.05), without serious complications. Conclusions: It is a good method that bilateral superficial cervical plexus never block anesthesia under the skin of neck (a frog-method) has the advantages of accurate 、simple、safe、practical 、effective 、cheap and less complications, so it was well worth clinical popularizing and application.

 

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