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目的比较采用超声引导和神经电生理监测下进行小儿臂丛神经阻滞的临床效果。方法 60例美国麻醉师协会(ASA)Ⅰ级的闭合尺、桡骨骨折患儿,随机等分为传统解剖定位组(C组)和超声引导组(US组),均行神经电生理监测肌肉复合动作电位(CMAP)监测,局部麻醉采用0.2%左布比卡因0.4mL/kg肌间沟臂丛神经阻滞。观察两组麻醉操作完成时间、桡神经阻滞起效时间、麻醉术中氯胺酮的用量、术后麻醉恢复室停留时间,及并发症发生情况。结果 US组麻醉操作完成时间[(4.42±0.47)min]高于C组[(2.78±0.53)min],差异有统计学意义(P<0.05)。US组桡神经阻滞起效时间[(7.63±1.56)min]低于C组[(9.89±1.67)min],差异有统计学意义(P<0.05)。US组氯胺酮的用量[(31.3±10.6)mg]低于C组[(60.6±11.7)mg],差异有统计学意义(P<0.01)。US组术后麻醉恢复室停留时间[(18.7±6.9)min]低于C组[(30.6±10.7)min],差异有统计学意义(P<0.05)。结论超声引导小儿臂丛神经阻滞能明显减少全身麻醉药量,临床效果更好;CMAP是神经阻滞的客观和量化的观察指标,有临床应用价值。
Objective To compare the clinical effects of pediatric brachial plexus block with ultrasound guided and electrophysiological monitoring. Methods Sixty ASA class Ⅰ occlusion rulers and children with radial fractures were randomly divided into two groups: traditional anatomical group (C group) and ultrasound guided group (US group) Action potential (CMAP) monitoring, local anesthesia with 0.2% levobupivacaine 0.4mL / kg intermuscular brachial plexus block. The completion time of anesthesia operation, the onset time of radial nerve block, the dosage of ketamine during anesthesia, the residence time of postoperative anesthesia recovery room, and the complication were observed. Results The completion time of anesthesia in US group [(4.42 ± 0.47) min] was significantly higher than that in C group [(2.78 ± 0.53) min) (P <0.05). The onset time of radial nerve block in the US group was significantly lower than that in the C group [(7.63 ± 1.56) min vs (9.89 ± 1.67) min, P <0.05). The dosage of ketamine in the US group [(31.3 ± 10.6) mg] was lower than that in the C group [(60.6 ± 11.7) mg], the difference was statistically significant (P <0.01). The retention time of postoperative anesthesia recovery room in US group [(18.7 ± 6.9) min] was lower than that in C group [(30.6 ± 10.7) min), the difference was statistically significant (P <0.05). Conclusion Ultrasound-guided pediatric brachial plexus block can significantly reduce the amount of general anesthesia, the clinical effect is better; CMAP is an objective and quantitative observation of nerve block, with clinical value.