Bennani S E, Vandenabele-Teneur F, Nyarwaya J B, Delecroix M, Krivosic-Horber R
Département d'Anesthésie-Réanimation Chirurgicale I, Hôpital Roger Salengro (Hôpital B), Lille, France.
Eur J Anaesthesiol. 1998 Jul;15(4):453-6. doi: 10.1046/j.1365-2346.1998.00325.x.
The brachial plexus was identified by electrical stimulation before interscalene block with 30 mL 0.5% bupivacaine and adrenaline 1:200,000. During injection, compression was applied with a finger proximal to the injection site. Spirometric measurements were made before the block, and then at 5 min, 10 min, 20 min and 4 h after the injection. Diaphragmatic excursion was measured radiographically before the block, and at 15 min and 4 h afterwards. In 25 patients studied, spirometric measurements decreased. Twenty minutes after the injection, the forced vital capacity was 27% less, forced expiratory volume at 1 s 34% less and peak expiratory flow rate 15% less (all P < 0.05). Right diaphragmatic excursion decreased from 4.5 cm (SD 1.2 cm) to 1.8 cm (0.6 cm) at 15 mins and to 1.1 cm (0.6 cm) at 4 h (P < 0.05). Identification of the plexus by electric stimulation combined with finger compression above the injection site did not prevent diaphragmatic paresis.
在肌间沟阻滞前，通过电刺激识别臂丛神经，然后注入30毫升0.5%布比卡因和1:200,000肾上腺素。注射过程中，在注射部位近端用手指施加压迫。在阻滞前、注射后5分钟、10分钟、20分钟和4小时进行肺活量测定。在阻滞前、阻滞15分钟后和4小时后进行X线透视测量膈肌移动度。在研究的25例患者中，肺活量测定值下降。注射后20分钟，用力肺活量减少27%，1秒用力呼气量减少34%，呼气峰值流速减少15%（均P<0.05）。右膈肌移动度在15分钟时从4.5厘米（标准差1.2厘米）降至1.8厘米（0.6厘米），在4小时时降至1.1厘米（0.6厘米）（P<0.05）。通过电刺激结合在注射部位上方的手指压迫来识别神经丛并不能防止膈肌麻痹。
