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上海市卫生健康委员会
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超声定位在肥胖患者肌间沟臂丛神经阻滞的应用
Application of ultrasound-guided interscaline brachial plexus block in obese patients

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DOI:
作者:
牟戎，王业贵
Mu Rong
作者单位:
天津市第四中心医院麻醉科
Department of Anesthesiolog，Tianjin 4TH Centre Hospital，Tianjin 300140，China
关键词:
超声；臂丛神经阻滞；肥胖
Ultrasonagraphy; Brachial plexus nerve block; Obesity
摘要:
摘要 ：目的　比较超声引导 (U组)定位与神经刺激器(N组)定位行肌间沟臂丛神经阻滞用于肥胖患者的效果及安全性。方法　选择拟行上肢手术、体质量指数（BMI）>30kg/m2的患者40例,ASAⅠ或Ⅱ级,随机均分为U组和N组。两组均给予0. 5%的罗哌卡因。记录完成操作所需时间、感觉阻滞起效时间、感觉阻滞效果、和两组局麻药的用量，评定手术全程的麻醉效果，记录并发症。结果　U组完成操作所需时间明显短于N组的(P＜0.05)，感觉阻滞起效时间快、局麻药用量少 (P＜0.05)，尺神经、正中神经、前臂内侧皮神经感觉阻滞完善率高于N组(P＜0.05)。U组麻醉效果较N组好（P＜0.05）。U组未出现并发症，N组有4例患者出现与神经阻滞相关的并发症。结论　肥胖患者在超声引导下行肌间沟臂丛神经阻滞操作时间短,阻滞起效快,效果好,局麻药用药量少，并发症少，值得临床推广应用。
【Abstract】　Objective:　To compare the efficacy and safety of interscaline brachial plexus block in obese patients under the guidance of ultrasonagraphy (U group) with nerve stimulator (N group). Methods:　Forty body mass index (BMI)> 30kg/m2,ASA classⅠorⅡpatients scheduled for upper extremity operation were randomized to group U and group N with 20 cases each. Both groups were given0. 5% ropivacaine. Record the time required to complete the operation, sensory block onset time, sensory block effect, and the amount of local anesthetic agents to assess the effects of anesthesia throughout surgery, recording of complications. Results:　 U group to complete the operation time was shorter in N group (P <0.05). Faster onset time of sensory block, local anesthetic agents less (P <0.05), ulnar nerve, median nerve, cutaneous nerve sensory block in improving high (P <0.05). The quality of anesthesia in Group U was superior to that in Group N (P <0.05). U group without complications, N group, four cases of patients with nerve block-related complications. Conclusion: obese patients by ultrasound guided interscalene brachial plexus block operation time is short, block rapid onset of effect, less local anesthetic agents, fewer complications, is worthy of clinical application.

 

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