不同臂丛神经阻滞法在肘关节术后镇痛及早期功能锻炼的临床效果

Clinic Observation for Elbow Postoperative Analgesia and Early Active Mobilization in Different Axillary Brachial Plexus Block Methods

目的比较单次与连续臂丛神经阻滞对于肘关节手术患者术后镇痛及早期功能锻炼效果的改善情况。方法选择80例ASAⅠ~Ⅱ择期行肘关节手术患者,随机分为连续臂丛阻滞组（C组）及静脉镇痛组（I组）,C组于术后采用连续臂丛神经阻滞镇痛法,I组术后采用单次神经阻滞联合静脉自控镇痛法。观察两组患者术后不同时点的镇痛、镇静、肘关节功能锻炼及不良反应等情况。结果两组术后恶心呕吐发生率及术后镇痛药物使用情况均显示C组明显低于I组,差异有统计学意义（P〈0.05）;C组除了术后2h的静止和运动VAS疼痛评分以及术后2h的Ramsay镇静评分同I组相比差异无统计学意义（P〉0.05）,其他各时点的静止和运动VAS疼痛评分和Ramsay镇静均低于I组,差异有统计学意义（P〈0.05）,两组间各时点Broberg和Morrey评分差异无统计学意义（P〉0.05）。结论连续臂丛神经阻滞可为肘关节手术提供更加满意的术后镇痛效果,减少因大量应用中枢性镇痛药带来的不良反应,提高术后生活质量,有利于患者早期进行功能锻炼。

Objective Observe the recovery matters of the elbow surgery patients＇ postoperative analgesia and early functional training effect by using single or continuous axillary brachial plexus block. Methods Eighty ASA Ⅰ / Ⅱ patients undergoing elective elbow surgery were stochastically divided into continuous axillary brachial plexus block group（ group C） and intravenous analgesia group（ group I）. Continuous axillary brachial plexus block is used in group C,and single nerve block united intravenous controlled analgesia is for group I. Postoperative pain,analgesia,elbow active mobilization and untoward effects in different time points of the patients in two groups are observed. Results In aspects of the rate of nausea and vomiting and the amount of postoperative analgesia usage,the value of group C is much lower than that of group I. The VAS pain scores（ rest and active） and Ramsay analgesia scores in group C are lower than that of group I in all time-points but 2-hour-VAS pain scores（ rest and active）and 2-hour-Ramsay analgesia scores after operation are the same. There＇re no obvious differences in Broberg and Morrey scores in all time points for the two groups. Conclusion Better postoperative analgesia effect for elbow surgery patients comes from continuous axillary brachial plexus block,which reduces the untoward effect by largely using central analgesia to improve postoperative living quality and make for patients＇ active mobilization in early phase.