肌间沟及腋路臂丛神经联合阻滞在上肢手术中的应用

目的探讨肌间沟阻滞法、腋路臂丛阻滞法和肌间沟及腋路臂丛联合阻滞3种不同方法在同时涉及上肢尺、桡神经支配区域手术中的麻醉效果。方法选择我院2011年1月～2011年7月多根手指外伤且外伤范围涉及拇指与小指需进行清创缝合的60例,随机分为A、B、C3组,A组采用肌间沟阻滞法、B组采用腋路臂丛阻滞法、C组采用肌间沟和腋路臂丛联合阻滞法。麻醉完成20 min后采用针刺法检验麻醉效果,并使用视觉模拟评分法（VAS）对麻醉效果进行评价。结果麻醉完成20 min后,C组在尺神经支配区域的麻醉效果优于A组,在桡神经支配区域的麻醉效果优于B组,差异有统计学意义（P〈0.05）。采用VAS评价疼痛程度,A组与C组尺侧评分比较差异有统计学意义（t=6.9793,P〈0.05）;B组与C组桡侧评分比较差异亦有统计学意义（t=6.7626,P〈0.05）;A组与C组的桡侧、B组与C组的尺侧评分比较差异均无统计意义（t=0.1833,t=0.4727,P均〉0.05）。结论肌间沟及腋路臂丛神经联合阻滞在上肢手术,尤其是同时涉及尺、桡神经支配区域的手术中具有更好的麻醉效果。

The Application of Muscle Intergroove Blocking Combined with Armpit Brachial Plexus Blocking in Operations on the Upper Extremity

Objective To discuss the anaesthetic effects of such methods as muscle intergroove blocking,armpit brachial plexus blocking,the combination of muscle intergroove blocking and armpit brachial plexus blocking in operations involving areas innervated by both ulnar nerves and radial nerves of the upper extremity.Methods 60 cases of more than one finger trauma and trauma range involving the thumb and little finger undergoing debridement surgery in our hospital during January 2011 and July 2011 were randomly divided into group A,B and C.Group A underwent muscle intergroove blocking,group B armpit brachial plexus blocking,group C the combination of muscle intergroove blocking and armpit brachial plexus blocking.Acupuncture anesthesia was used to test anesthetic effect 20 min later,and the visual analog scale(VAS) was used to evaluate the anesthetic effect.Results 20 min after anesthesia,the effects in the ulnar nerve dominating regional anesthesia was better in group C than in group A.Effects of disposable regional anesthesia were better than that of group B,and the difference was statistically significant(P<0.05).The VAS evaluation of the degree of pain showed that thse was significant difference in ulnar scores between group A and C(t=6.9793,P<0.05);compared with group C,scores of radial side in group B showed statistically significant differences(t=6.7626,P<0.05).In scores of the radial side of group A and group C,and the ulnar scores of group B and group C,differences were not statistically significant(t=0.1833,t=0.4727,P>0.05).Conclusion The combination of muscle intergroove blocking and armpit brachial plexus blocking has preferable anaesthetic effects on operations on the upper extremities,especially those involving areas innervated by both ulnar nerves and radial nerves.