THE APPLICATION OF PULSE OXIMETER FOR SUPRACLAVICULAR BRACHIAL BLOCK

應用Pulse Oximeter施行鎖骨上臂神經叢阻斷術

林仙養(Shian-Yeang Lin) ； 江洽榮(Chung-Jong Jiang) ； 劉健強(Kien-Cuoung Luu) ； 吳宗正(Tzong-Jen Wu) ； 黃琴喨(Ching-Leung Hwang) ； 孫維仁(Sun-Wei Zen) ； 黃芳彥(Fan-Yen Huang) ； 趙繼慶(Chi-Ching Chao)

《Acta Anaesthesiologica Sinica》 28卷1期 (1990/03) Pp. 43-48

摘要

The subclavian artery is the most important landmark of the supraclavicular brachial block. However, it is difficult to locate the artery by palpation in the patients with poor landmark. The present study was aimed to compare two localizing methods of the subclavian artery by a pulse oximeter or by palpation. One hundred patients were divided into three groups. Group A (Slim Group): 6 patients, Group B (Normal Weight Group): 75 and Group C (Obses Group): 19. All patients received both methods locate the subelavion artery. The first method was by palpating the pulsation of the subclavian artery. The second was by observing the wave depression of the pulse oximeter while pressing supraclavicular area. It was found that the detection rate of the first method was 83.3 % in Group A, 52.0% in Group B, 26.3% in Group C and 49.0% in overall patients. However, the detection rate of the second method was 100 % in each group. It shows a significant difference between the two methods in Group B, Group C and all patients (P＜0.001), but no difference in Group A (P=0.68). There were 13 patients among the 100 patients undergoing surgery of the upper extremity. Seven of them whose pulsation was not clearly palpated but could be exactly by pulse oximeter. Supraclavicular brachial block was still completed successfully in these 13 patients. No pneumothorax was found. Utilizing pulse oximeter in supraclavicular block provides a high detection rate of the pulsation of the subclavian artery and improves the reliablility of the block, especially in the patients with poor landmark.

關鍵字

Brachial plexus ； Supraclavicular approach ； Subclavian artery ； Pulse oximeter

並列摘要

鎖骨下動脈是施行鎖骨上臂神經叢阻斷術重要的標界點，但在肥胖、短頸、燙傷或肌肉型的病人，此動脈常無法正確定位。本實驗利用Pulse oximeter波型的改變來定位此動脈，在百位病人中得到百分之百的成功率，更傳統的觸脈法僅得到百分之四十九的成功率。依據所定位的動脈位置，在十三個病人身上施行鎖骨上臂神經叢阻斷術，皆得到良好的麻醉效果，並且無併發症發生。我們建議：使用Pulse oximeter定位鎖骨下動脈，施行鎖骨上臂神精叢阻斷術，爲安全，有效且可靠的方法。