经皮超声引导锁骨上臂丛神经阻滞麻醉对尺桡骨双骨折患者术后疼痛程度及并发症的影响

Effect of percutaneous ultrasound-guided supraclavicular brachial plexus block anesthesia on pain degree and complication rate of patients with radius and ulna fractures

目的探讨经皮超声引导锁骨上臂丛神经阻滞麻醉对尺桡骨双骨折患者术后疼痛程度及并发症的影响。方法选取2015年1月至2018年3月江苏省常州市第四人民医院接收的尺桡骨双骨折患者104例,采用随机数字表法分为研究组52例和对照组52例。两组均行手术治疗,对照组采用盲探法臂丛神经阻滞麻醉,研究组采用经皮超声引导锁骨上臂丛神经阻滞麻醉。观察比较两组患者麻醉情况(麻醉阻滞操作用时、麻醉药物用量、麻醉效果评分、麻醉持续时间)、臂丛神经主要分支(桡神经、尺神经、正中神经、肌皮神经)阻滞起效时间、围术期不同时段[切皮前(T0)、切皮后(T1)、术中30min(T3)、术后5min(T4)]的血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]、术后不同时间点疼痛程度[视觉模拟评分法(visual analogue scale,VAS)评分]及并发症发生情况。结果研究组麻醉阻滞操作用时、麻醉药物用量、麻醉效果评分、麻醉持续时间优于对照组(P<0.05),桡神经、尺神经、正中神经、肌皮神经阻滞起效时间短于对照组(P<0.05),T1、T2及T3时段HR、MAP低于对照组(P<0.05)。术后0.5h、24h两组VAS评分比较差异无显著性(P>0.05),术后3h、6h、12h研究组VAS评分低于对照组(P<0.05)。研究组并发症发生率为5.77%(3/52),低于对照组23.08%(12/52),差异有显著性(P<0.05)。结论经皮超声引导锁骨上臂丛神经阻滞麻醉能明显提高麻醉效果,加快麻醉起效时间,且能维持患者围术期血流动力学稳定,降低术后疼痛程度,减少并发症的发生,具有较高应用价值。

Objective To study the effect of percutaneous ultrasound-guided supraclavicular brachial plexus block anesthesia on pain degree and complication rate of patients with double fracture of radius and ulna.Method From January 2015 to March 2018,104 cases of bilateral fractures of ulna and radius received in our hospital were randomly divided into study group and control group.Both groups were received the operation,the control group was anesthetized with brachial plexus block by blind exploration,while the study group was anesthetized with supraclavicular brachial plexus block guided by percutaneous ultrasound.The anesthesia situation(anesthesia block operation time,anesthetic dosage,anesthesia effect score,anesthesia duration),the onset time of brachial plexus nerve block(radial nerve,ulnar nerve,median nerve,musculocutaneous nerve),different perioperative periods[before skin incision(T0),after skin incision(T1),30 minutes(T3),5 minutes(T4)]Academic indicators[heart rate(HR),mean arterial pressure(MAP)],degree of pain(VAS score)and complications at different time points after surgery.Result①Anesthesia condition:The anesthesia operation time,anesthetic dosage,anesthetic effect score and duration of anesthesia in the study group were better than that in the control group(P<0.05);②The onset time of brachial plexus nerve block was shorter in the study group than that in the control group(P<0.05);③Change of hemodynamic indicators in perioperative period:HR and MAP values in the study group were lower than that in the control group at T1,T2 and T3 periods,and the fluctuation range of HR and MAP values in the study group was smaller than that in the control group(P<0.05);④pain degree in perioperative period:VAS scores in the study group were not significantly different from that in the control group at 0.5h and 24h after operation(P>0.05);VAS scores in the study group were lower than that in the control group at 3h,6h and 12h after operation(P<0.05);⑤Complications:Study group:The incidence of complications was 5.77%(3/52)lower than 23.08%(12/52)in the control group(P<0.05).Conclusion Percutaneous ultrasound-guided supraclavicular brachial plexus block anesthesia can significantly improve the anesthesia effect,accelerate the onset time of anesthesia,and maintain hemodynamic stability in perioperative period,reduce the degree of pain after operation and the incidence of complications,which has high application value.