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題名 | Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block: A Comparative Study with Nerve Stimulator-Guided Method=超音波導引與神經刺激器導引術在腋下臂神經叢阻斷上之比較 |
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作者 | 柳復兆; 劉錦棠; 蔡永豐; 李漢倫; 戴元基; 許汝寧; 呂炳榮; | 書刊名 | 長庚醫學 |
卷期 | 28:6 2005.06[民94.06] |
頁次 | 頁396-402 |
分類號 | 416.5 |
關鍵詞 | 超音波導引; 神經刺激器導引; 腋神經叢阻斷; Ultrasound-or nerve stimulator-guided; Axillary brachial plexus block; |
語文 | 英文(English) |
中文摘要 | 背景:比較超音波導引術及神經刺激術在腋下臂神經叢阻斷上之效能;並同時比較在超音波導引下單點與雙點注射其麻醉阻斷能力之差異。 方法:本實驗共有90位接受前臂和手部之病患,以隨機分配的方式分乘3組,每組均為30位病患。第一組為利用神經刺激器雙點注射,第二組為利用超音波導引雙點注射,第三組為利用超音波導引單點注射。每一位病患均接受含5mg kg-1 epinephrine 總量0.5ml kg-1 之1.5% lidocaine局部麻藥於腋下臂神經叢注射,第一組在利用神經刺激器找到正中神經後先給予神經周圍半量局部麻藥注射,然後再找到尺神經或橈神經給予另外半量注射。第二組在超音波導引下找到腋動並與第一組相同高度之腋動脈內、外緣做雙點注射。第三組為同樣利用超音波導引在相同腋下位置,僅定位在腋動脈外緣單點注射。麻醉阻斷程度之評估,包括手臂7條感覺神經和4條運動神經。 結果:在神經刺激器雙點注射組和超音波導引單點注射組均獲得70%足夠感覺和運動阻斷,在超音波導引雙點注射獲得73%足夠感覺和運動阻斷。對於滿足手術完成之阻斷成功率,在神經刺激器雙點注射組和超音波導引雙點注射組是90%,超音波導引單點注射組是70%;至於併發症之發生率,在神經刺激器雙點注射組是20%,較超音波導引注射兩組之0%高,並有統計上意義(p=0.03)。 結論:超音波導引腋下臂神經叢阻斷術無論是單點或雙點注射法均能提供較優良之感覺和運動阻斷並較少併發症。 |
英文摘要 | Background: The aim of this study was to compare the efficacy of axillary brachial plexus block using an ultrasound-guided method with the nerve stimulator-guided method. We also compared the efficacy of ultrasound-guided single-injection with those of double-injection for the quality of the block. Methods: Ninety patients scheduled for surgery of the forearm or hand were randomly allocated into three groups (n=30 per group), i.e., nerve stimulator-guided and double-injection (ND) group, ultrasound-guided and double-injection (UD) group, and ultrasound-guided and single –injection (US) group. Each patient received 0.5 ml kg-1 of 1.5% lidocaine with 5 mg kg-1 epinephrine. Patients in the ND group received half the volume of lidocaine injected near the median and radial nerves after identification using a nerve stimulator. Patients in the UD group received half the volume of lidocaine injected around the lateral and medial aspects of the axillary artery, while those in the US group were given the entire volume near the lateral aspect of the axillary artery. The extent of the sensory blockade of the seven nerves and motor blockades of the four nerves were assessed 40 min after the performance of axillary brachial plexus block. Results: Seventy percent of the patients in the ND and US groups as well as 73% of the patients in the UD group obtained satisfactory sensory and motor blockades. The success rate of performing the block was 90% in patients in the ND and UD groups and 70% in the US group. The incidence of adverse events was significantly higher in the ND group (20%) compared with that in the US group and the UD group(0%;p=0.03). Conclusions: Ultrasound-guided axillary brachial plexus block, using either single-or-double-injection technique, provided excellent sensory and motor blockades with fewer adverse events. |
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