腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术

The application of subclavicular brachial plexus block with localized puncture at the apex of the axilla on the treating of traumatic brachial plexus injury

目的探讨腋窝顶定位穿刺锁骨下位点阻滞麻醉用于创伤性臂丛损伤手术的可行性。方法 60例患者随机均分为3组,A组:腋窝顶定位穿刺锁骨下位点阻滞麻醉;B组:插管全麻;C组:腋窝顶定位穿刺锁骨下位点阻滞复合插管全麻,术后用PCIA泵镇痛和VAS评价镇痛程度。评估术中除共同项目外,麻醉技术、耗材和药品所产生的医疗费用。结果 3组患者一般情况比较差异无统计学意义(P>0.05);术中全麻丙泊酚和瑞芬太尼每小时应用剂量、术后唤醒和拔管定向力恢复时间,B组显著多或长于C组(P<0.01);麻醉前准备、操作完成时间A组<B组<C组,组间两两比较差异显著(P<0.01);麻醉维持时间A、C两组显著长于B组(P<0.01),患者离开手术室时间A组显著短于B、C两组(P<0.01),术后24 h 5个时间点VAS评分、术后泵用镇痛药氯诺昔康24 h应用总量、术中麻醉技术和耗材及药品总费用A组<C组<B组,组间两两比较差异显著(P<0.01)。结论腋窝顶定位穿刺锁骨下位点阻滞麻醉可选择性用于创伤性臂丛损伤手术,其麻醉效果和安全性与插管全麻相似,且操作简便、医疗费用低。

Objective To investigate the feasibility ofsubclavicular brachial plexus block with localized puncture at the apex of the axilla on treating of traumatic brachial plexus damage. Methods 60 patients were randomly divided into group A （subclavicular brachial plexus block with localized puncture at the apex of the axilla）, group B （tracheal intubation anesthesia）, and group C （subclavicular brachial plexus block with localized puncture at the apex of the axilla together with tracheal intubation anesthesia）. Patient-controlled intravenous analgesia （PCIA） was used to evaluate the degree of analgesia by visual analog scale （VAS） after operation, as well the cost of anesthesia technique, material and medicines except common project was evaluated. Results There were no statistically difference among the three groups in generic index （P〉0.05）. The every hour dosage of propofol and remifentamil of group B were higher than group C （P〈0.01）. The postoperative awakening time and orientation time of group B were longer than group C （P〈0.01）. There were no significant difference between two groups for preparing time, and performing time （group A〈 group B〈 group C）. The duration of anesthesia of group A and C were significantly longer than group B （P〈0.01）. There were significantly difference in VAS score at 5 time points after operation, the total dosage of Lornocines for 24 hour, anesthesia technique, material and the total cost of drugs among 3 groups （A 〈C 〈 B）. Conclusions Subclavicular brachial plexus block with localized puncture at the apex of the axilla can be selectively used in traumatic brachial plexus injury surgery with the same anesthetic effect and security as general anesthesia, together with easier operation and less medical cost.