Li Ting, Ye Xian-hua, Nan Yang, Shi Tong, Ye Qi-gang, Ma Jian-feng, Li Jun
Department of Anesthesiology, Wenzhou Medical College, Wenzhou, China.
Zhonghua Yi Xue Za Zhi. 2013 Jan 15;93(3):187-90.
To compare ultrasound guidance versus nerve stimulator guidance supraclavicular brachial plexus block for regional hemodynamic changes of upper extremity.
Sixty ASA I-II patients scheduled for upper extremity operation were randomly assigned to receive a supraclavicular brachial plexus block guided by either ultrasound (U group, n = 30) or nerve stimulation (N group, n = 30).20 ml mixture of equal volumes of 2% lidocaine and 0.75% ropivacaine was injected in both groups. Regional hemodynamic parameters were measured in the ipsilateral ulnar artery and radial artery, using pulsed-wave Doppler ultrasound, before and 30 minutes after the block. Regional hemodynamic parameters included peak systolic velocity (PSV), end-diastolic velocity (EDV), time averaged maximum velocity (TAMAX), resistance index (RI), pulsatility index (PI), cross-sectional area (Area) and Blood flow (Q). The intensity of sensory block was measured at 30 minutes after the block.
There was no significant difference in the hemodynamic parameters of ulnar artery and radial artery before the block between two groups. Compared with N group, EDV, TAMAX and Q of ulnar artery were higher in U group (1.88-fold, 1.71-fold and 1.84-fold)(P < 0.01 or P < 0.05), PI and RI of ulnar artery were lower in U group (P < 0.01) at 30 minutes after the block, EDV of radial artery was higher in U group (1.47-fold) (P < 0.01), PI and RI of radial artery were lower in U group (P < 0.05) at 30 minutes after the block. Comparing the hemodynamic parameters of ulnar artery and radial artery with complete block between two groups at 30 minutes after the block, EDV, TAMAX and Q of ulnar artery in U group were higher than that in N group (1.68-fold, 1.55-fold and 1.62-fold) (P < 0.01 or P < 0.05), PI of ulnar artery in U group was lower than that in N group (P < 0.01), EDV and TAMAX of radial artery in U group was higher than that in N group (1.54-fold and 1.26-fold) (P < 0.01 or P < 0.05), PI and RI of radial artery in U group was lower than that in N group (P < 0.05). The rate of complete block in U group was higher than that in N group (28/30 vs 22/30, P < 0.05).
Ultrasound-guided supraclavicular brachial plexus block enhance the degree of sympathetic block of upper extremity, especially of ulnar artery and increase the blood flow of ulnar artery compared with nerve stimulator.
比较超声引导与神经刺激器引导锁骨上臂丛神经阻滞对上肢局部血流动力学变化的影响。
将60例拟行上肢手术的ASA I-II级患者随机分为两组，每组30例。超声引导组（U组）采用超声引导锁骨上臂丛神经阻滞，神经刺激器引导组（N组）采用神经刺激器引导锁骨上臂丛神经阻滞。两组均注射20 ml由等体积的2%利多卡因和0.75%罗哌卡因混合而成的溶液。在阻滞前及阻滞后30分钟，使用脉冲波多普勒超声测量同侧尺动脉和桡动脉的局部血流动力学参数。局部血流动力学参数包括收缩期峰值流速（PSV）、舒张末期流速（EDV）、时间平均最大流速（TAMAX）、阻力指数（RI）、搏动指数（PI）、横截面积（Area）和血流量（Q）。在阻滞后30分钟测量感觉阻滞强度。
两组阻滞前尺动脉和桡动脉的血流动力学参数无显著差异。与N组相比，阻滞后30分钟，U组尺动脉的EDV、TAMAX和Q更高（分别为1.88倍、1.71倍和1.84倍）（P<0.01或P<0.05），U组尺动脉的PI和RI更低（P<0.01）；阻滞后30分钟，U组桡动脉的EDV更高（1.47倍）（P<0.01），U组桡动脉的PI和RI更低（P<0.05）。比较两组阻滞后30分钟完全阻滞时尺动脉和桡动脉的血流动力学参数，U组尺动脉的EDV、TAMAX和Q高于N组（分别为1.68倍、1.55倍和1.62倍）（P<0.01或P<0.05），U组尺动脉的PI低于N组（P<0.01）；U组桡动脉的EDV和TAMAX高于N组（分别为1.54倍和1.26倍）（P<0.01或P<0.05），U组桡动脉的PI和RI低于N组（P<0.05）。U组的完全阻滞率高于N组（28/30 vs 22/30，P<0.05）。
与神经刺激器引导相比，超声引导锁骨上臂丛神经阻滞可增强上肢尤其是尺动脉的交感神经阻滞程度，并增加尺动脉血流量。
