摘要目的 探讨超声和神经刺激仪引导行双侧腋路臂丛神经阻滞的有效性和安全性.方法 收集2012年2月至2014年4月北京积水潭医院行双侧手/前臂手术患者120例,所有患者均于双侧腋路臂丛阻滞下手术.应用随机数字表法将患者随机分为2组:超声引导组(U组,n =60)和神经刺激仪引导组(N组,n =60),局麻药选择0.5％罗哌卡因.记录患者年龄、性别、手术时间等资料,同时记录阻滞成功率、操作时间、感觉和运动阻滞起效时间、操作痛、患者满意度和并发症的发生率.在不同时间点采集静脉血样本并应用高效液相色谱法(HPLC)检测血浆罗哌卡因浓度.结果 U组的操作时间、感觉阻滞起效时间和运动阻滞起效时间分别为(8.2±1.5)、(14.2±2.2)、(24.0±3.5)min,均明显短于N组的(14.6±3.9)、(19.9±3.8)、(28.8±4.2)min,差异有统计学意义(t=11.74、10.09、6.73;均P＜0.01).U组的操作痛为(25.5±13.2)分,明显低于N组的(31.7±11.2)分,差异有统计学意义(t =2.856,P＜0.05).U组患者满意度为95.0％,明显高于N组的83.3％,差异有统计学意义(x2=4.227,P＜0.05).阻滞操作完成后50 min时,U组血浆总罗哌卡因浓度为(1.76±0.48) mg/L,明显低于N组的(1.88±0.53) mg/L,差异有统计学意义(t=2.43,P＜0.05);而其余各时间点差异均无统计学意义(均P＞0.05).所有患者均未追加其他镇痛药物及更换麻醉方式,围手术期均未发现明显麻醉相关并发症.结论 超声和神经刺激仪引导下实施的双侧腋路臂丛神经阻滞均可安全有效地用于双侧手/前臂手术,但超声引导时操作时间短、起效迅速且患者满意度高,更适于临床应用.

abstractsObjective To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator.Methods From February 2012 to April 2014,120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block.All patients were divided into two groups randomly using random number table:the ultrasound-guided group (group U,n =60) and the neurostimulatorguidedgroup (group N,n =60).The block was performed with 0.5％ ropivacaine.Patients' age,sex and operation duration were recorded.Moreover,success rate,performance time,onset of sensor and motor block,performance pain,patient satisfaction degree and the incidence of related complications were also documented.Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC.Results The performance time,the onset of sensor block and the onset of motor block of group U were (8.2 ± 1.5),(14.2 ± 2.2) and (24.0 ± 3.5) min respectively,which were markedly shorter than those in group N((14.6 ± 3.9),(19.9 ± 3.8),(28.8 ± 4.2) min,respectively),and the differences were statistically significant (t =11.74,10.09,6.73,respectively,all P ＜ 0.01).The performance pain score of group N was (25.5 ± 13.2),which was obviously more serious than group U (31.7 ± 11.2) and a significant statistical difference was detected (t =2.856,P ＜ 0.05).The patient satisfaction degree of group U was 95.0％,which was significantly higher than group N (83.3％) and a markedly statistical difference was detected (x2 =4.227,P ＜ 0.05).Fifty min after performance,the total plasma concentration of ropivacaine of group U was (1.76 ± 0.48) mg/L,which was significantly lower than group N (1.88 ± 0.53) mg/L and a significant statistical difference was detected (t =2.43,P ＜ 0.05),while no significant differences were detected at the other time points between two groups (P ＞ 0.05).No analgesic was superadded and no other anesthesia methods were applied.No complications were detected perioperatively.Conclusions The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/ forearm surgery.However,the ultrasound-guided block may be more clinically beneficial because of its shorter performance time,rapid onset and higher patient satisfaction degree.