单纯颈丛阻滞麻醉和颈丛臂丛联合阻滞麻醉在锁骨骨折手术患者中的应用对比

Comparison of Simple Cervical Plexus Block Anesthesia Combined Cervical Plexus-brachial Plexus Block Anesthesia in Patients with Clavicular Fracture Surgery

目的比较单纯颈丛阻滞麻醉和颈丛臂丛联合阻滞麻醉对锁骨骨折手术患者的麻醉效果及安全性。方法选取佛山市南海区人民医院2016年1月—2018年6月收治的择期行切开复位内固定术成人锁骨骨折患者70例,随机分为对照组和观察组,各35例。对照组术中行单纯颈丛阻滞麻醉,观察组术中行颈丛臂丛联合阻滞麻醉。比较两组麻醉效果、不良反应及手术过程生命体征、疼痛视觉模拟评分(VAS)变化。结果观察组麻醉优良率高于对照组(P<0.05);两组不良反应发生率无明显差异(P>0.05);两组患者不同时点心率(HR)及非侵入性血压(NIBP)水平交互比较有差异,切皮时、骨折复位时对照组HR及NIBP水平上升,观察组HR及NIBP水平下降(P<0.05);观察组术后1h、2h、4h疼痛VAS评分均低于对照组(P<0.05),术后6h两组疼痛评分无差异(P>0.05)。结论颈丛臂丛联合阻滞麻醉相较于单纯颈丛阻滞麻醉对锁骨骨折手术患者麻醉效果较好,基本能完全阻滞锁骨周围组织。

Objective To compare the efficacy and safety of cervical plexus block anesthesia and cervical plexus brachial plexus block anesthesia in patients undergoing clavicular fracture surgery. Methods 70 adult patients with clavicular fracture who underwent open reduction and internal fixation from January, 2016 to June, 2018 were randomly divided into control group and observation group,with 35 cases in each group. The control group received simple cervical plexus block anesthesia,while the observation group underwent cervical plexus brachial plexus block anesthesia. The effects of anesthesia,adverse reactions,vital signs and visual ana logue pain score(VAS)were compared between the two groups. Results The excellent and good rate of anesthesia in the observation group was higher than that in the control group(P<0.05);there was no significant difference in the incidence of adverse reactions be tween the two groups(P>0.05);the heart rate(HR)and non-invasive blood pressure(NIBP)levels of the two groups were signifi cantly different at different time points;the levels of HR and NIBP in the control group increased during skin incision and fracture re duction;and the HR and NIBP levels in the observation group decreased(P<0.05),VAS scores of pain in observation group were lower than those in control group in 1,2 and 4 hours after operation(P<0.05),and there was no difference between two groups in 6 hours after operation(P>0.05). Conclusion The combined cervical plexus and brachial plexus block anesthesia is more effective than the simple cervical plexus block anesthesia in the treatment of clavicular fracture,and can block the periclavicular tissue completely.