锁骨骨折术中颈臂丛联合麻醉和单一臂丛麻醉的效果比较

Comparison of the Effect of Carotid Brachial Plexus Anesthesia and Single Brachial Plexus in Clavicular Fracture Fixation

目的比较锁骨骨折术中颈臂丛联合麻醉和单一臂丛麻醉的麻醉效果及不良反应。方法将2012年1月至2013年12月四川省科学城医院收治的58例美国麻醉医师协会分级Ⅰ-Ⅱ级锁骨骨折患者按照随机数字表法分为观察组（30例）和对照组（28例）。对照组采用单一臂丛麻醉，观察组采用颈臂丛联合麻醉，观察两组的麻醉效果、生命体征变化及不良反应发生情况。结果观察组的麻醉效果明显优于对照组，差异有统计学意义（P〈0．01）；麻醉后观察组的平均心率、平均呼吸频率及平均动脉压改变显著低于对照组[（72±4）次／min比（78±5）次／min，（15．2±2．3）次／min比（16．7±2．1）次／min，（71±6）mmHg（1mmHg=0．133kPa）比（79±7）mmHg]（P〈0．05），但麻醉后两组血氧饱和度差异无统计学意义（P〉0．05）；两组的不良反应发生率差异无统计学意义（P〉0．05）。结论颈臂丛联合麻醉的麻醉效果优于单一臂丛麻醉，对生命体征影响更小，是锁骨骨折理想的麻醉方式。

Objective To compare the anesthesia effect and adverse reaction of carotid brachial plexus anesthesia and single brachial plexus in clavicular fracture fixation. Methods Total of 58 patients with American Society of Anesthesiologists Ⅰ - ± clavicular fracture in the Science City Hospital of Sichuan Prov- ince from Jan. 2012 to Dec. 2013 were divided into observation group and control group according to random number table method. 30 cases in observation group received carotid brachial plexus anesthesia, and 28 cases in control group received single braehial plexus anesthesia. Anesthesia effect,adverse reaction and the impact on the vital signs in the two groups were observed. Results The anesthesia effect of the observation group was better than the control group, the difference was statistically significant （ P 〈 0.01 ）. After anesthesia, the average heart rate, average respiration and mean arterial pressure changes in the observation group were sig- nificantly lower than the control group [ （72 ± 4） times/rain vs （78 ± 5 ） times/rain, （ 15.2 ± 2.3 ） times/rain vs （ 16.7 ± 2.1 ） times/min, （71 ± 6 ） mmHg vs （79 ± 7 ） rmnHg ] （ P 〈 0.05 ）, but the oxygen saturation had no significant difference between the two groups（ P 〉 0.05 ） ; the incidence of adverse reactions of the two groups had no statistical difference（ P 〉 0.05 ）. Conclusion The anesthesia effect of carotid hrachial plexus anesthesia is better than single brachial plexus anesthesia, has smaller impact on the vital signs and low inci- dence of adverse reactions, thus is the ideal anesthetic method of clavicular fracture.