超声引导下肌间沟联合锁骨上入路臂丛神经阻滞在老年上肢手术患者中的应用效果

Application effect of brachial plexus nerve block under ultrasonic guidance via interscalene combined with supraclavicular approach in upper-limb surgery of elderly patients

目的探讨在超声引导下实行肌间沟联合锁骨上入路臂丛神经阻滞在老年上肢手术患者中的临床效果。方法选取2014年1月至2017年1月铜陵市人民医院收治的60例拟行上肢手术的老年患者,按随机数字表法将患者分为观察组30例与对照组30例。观察组采用超声引导下肌间沟联合锁骨上入路臂丛神经阻滞;对照组采用盲探肌间沟联合锁骨上入路臂丛神经阻滞。比较两组患者阻滞效果(优良率),臂丛各神经分支阻滞起效时间、完善时间、完善率和不良反应。结果观察组手术过程中,阻滞效果96.67%,优于对照组76.67%,差异有统计学意义(P<0.05);观察组臂丛各神经起效时间与阻滞完善时间均短于对照组,且阻滞完善率高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率3.33%低于对照组20.00%,差异无统计学意义(P>0.05)。结论老年上肢手术患者超声引导下肌间沟联合锁骨上入路臂丛神经阻滞成功率高、安全有效。

Objective To investigate the clinical effect of ultrasound-guided brachial plexus nerve block via interscalene combined with supraclavicular approach.Methods From Jan 2014 to Jan 2017,60 elderly patients admitted to our hospital for upper-limb surgery were selected and divided into the study group and the control group by means of random number table,30 cases in each group.In the study group,brachial plexus nerve block via interscalene combined with supraclavicular approach was performedunder ultrasonic guidance,and patients in the control group received blind brachial plexus block via interscalene combined with supraclavicular approach.The blockade effect(excellent rate),onset time of brachial plexus block of each branches,finished time of blockade,finished rate of blockade and adverse reactions between the two groups were compared.Results The blockade excellent rate during operation in the study group was 96.67%,which was better than the excellent rate of 76.67%in the control group,with significant difference between them(P<0.05).In the study group,onset time of brachial plexus block of each branches and finished time of blockade were shorter than those in the control group,but the finished rate of blockade was higher than that in the control group,the differences between the two groups were all statistically significant(P<0.05).The incidence of complications in the study group was not significantlyl ower than that in the control group(3.33%vs 20.00%;P>0.05).Conclusion Application of ultrasound-guided brachial plexus nerve block via interscalene combined with supraclavicular approach in the upper-limb surgery of elderly patients is safe and effective,with a high success rate.