超声引导下臂丛神经阻滞在小儿上肢手术的疗效分析

黄硕 饶荣 王翠宝 许淑珍 卢华辉

[摘要] 目的 探討超声引导下臂丛神经阻滞用于小儿上肢手术的麻醉效果及安全性。 方法 方便选取该院于2015年2月—2017年10月收治的64例行小儿上肢手术的患儿，随机分为超声引导下臂丛神经阻滞组（A组，n=32）和喉罩全麻组（B组，n=32）。于麻醉前、切皮、术中、术毕记录其血压（BP）、心率（HR）、血氧饱和度（SpO2），并比较两组麻醉起效时间、苏醒时间、不良反应发生率及术后镇痛效果。 结果 两组在手术中各观察时间点的BP、HR、SpO2差异有统计学意义，A组明显低于B组（P<0.01）。两组的苏醒时间[（6.3±4.8）min vs （35.23±4.1）min]比较差异有统计学意义（t=4.76， P<0.01），两组不良反应发生率（6.25% vs 37.5%）和追加镇痛药次数（3.12% vs 25.0%）比较也差异有统计学意义（χ2=4.293、5.395， P<0.05）。结论 超声引导下臂丛神经阻滞简单实用、麻醉起效快、用药少、苏醒时间短，疗效确切、安全可靠，是小儿上肢手术较理想的麻醉方法。

[关键词] 臂丛神经阻滞；超声；麻醉；小儿

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）05（a）-0187-04

Analysis of Curative Effect of Ultrasound-guided Brachial Plexus Block in Upper Limb Surgery in Children

HUANG Shuo， RAO Rong， WANG Cui-bao， XU Shu-zeh， LU Hua-hui

Department of Anesthesia， Xiamen Fifth Hospital， Xiamen， Fujian Province， 361101 China

[Abstract] Objective To study the anesthesia effect and safety of ultrasound-guided brachial plexus block in upper limb surgery in children. Methods 64 cases of children with upper limb surgery in our hospital from February 2015 to October 2017 were convenient selected and randomly divided into two groups with 32 cases in each， the group A were the ultrasound-guided brachial plexus block patients， the group B were the general anesthesia of laryngeal mask patients， and the BP， HR and SpO2 before anesthesia， at skin incision， in operation and after surgery， and the anesthesia onset time， awakening time， incidence rate of adverse reactions and postoperative analgesic effect were compared between the two groups. Results The differences in the BP， HR， SpO2 at various time points between the two groups were statistically significant， and the indicators in the group A were obviously lower than those in the group B（P<0.01）， and the difference in the awakening time between the two groups was obvious， with statistical significance[（6.3± 4.8）min vs （35.23±4.1）min]， （t=4.76，P<0.01）， and the differences in the incidence rate of adverse reactions and number of additional analgesics between the two groups were statistically significant[（6.25% vs 37.5%），（3.12% vs 25.0%）]， and the differences were statistically obvious （χ2=4.293、5.395， P<0.05）. Conclusion The ultrasound-guided brachial plexus block is simple and practical with rapid anesthesia and onset， few medications， short awakening time and the curative effect is definite， and it is safe and reliable， and it is an ideal anesthesia method of upper limb surgery in children.

[Key words] Brachial plexus block； Ultrasound； Anesthesia； Children

小儿因恐惧而不配合，上肢手术传统多采用喉罩全身麻醉，尽管喉罩全身麻醉较气管内插管全身麻醉有更少并发症[1]，但术中可出现呼吸、循环不稳定，苏醒延长，苏醒期躁动、梦魇等并发症，还可发生恶心、呕吐，给患儿带来很大风险[2]。超声引导下臂丛神经阻滞具有定位准确，对呼吸、循环干扰小等优点，成功率高、疗效好、安全性高，在小儿上肢手术中越来越受欢迎[3]。该院于2015年2月—2017年10月对32例小儿上肢手术应用超声引导下臂丛神经阻滞取得很好的麻醉效果，现报道如下。

1 资料与方法

1.1 一般资料

方便选取该组患儿共64例，随机分两组，臂丛神经阻滞组（A组）32例，男25例，7女例，平均年龄（7.23±3.16）岁，喉罩全麻组（B组）32例，男24例，女8例，平均年龄（7.15±4.31）岁。其中单侧肱骨骨折切开复位内固定术26例，单侧桡骨骨折切开复位内固定术30例，单侧上肢压榨伤8例。两组患儿的年龄、性别、体重、病情严重程度等比较差异无统计学意义（P>0.05），具有可比性。……