超声引导下腋路四点法神经阻滞在肥胖患者尺桡骨骨折手术中的麻醉应用研究

Advantages of Ultrasound-guided Four Point Nerve Block in the Operation of Ulna and Radius Fracture in Obese Patients

目的探讨超声引导下腋路四点法神经阻滞在肥胖患者尺桡骨骨折手术中的优势。方法方便选取2018年10月-2019年9月,该院骨科收治60例BMI>27 kg/m^2的臂丛神经麻醉的尺桡骨骨折外伤患者作为研究对象,分为超声引导组和盲探引导组,分别给予超声引导方法和盲探引导方法。对两组在麻醉状态下表现出来的手术效果(神经阻滞效果及次数等)进行统计和观察分析。结果超声引导下的臂丛神经麻醉的阻滞优良率为96.67%,高于盲探引导组盲探的神经阻滞优良率(76.67%),组间数据对比差异有统计学意义(χ^2=6.397,P<0.05)。此外在穿刺次数和不良反应等方面要明显优于常规盲探下的效果(P<0.05)。结论腋路四点法神经阻滞在肥胖患者尺桡骨骨折手术中采用超声引导,能够明显提高臂丛神经麻醉效果,提高神经阻滞优良率,减少穿刺次数,降低不良反应发生情况。

Objective To investigate the advantage of axillary four-point nerve block guided by ultrasound in the operation of ulnar radius fracture in obese patients. Methods From October 2018 to September 2019, 60 patients with ulnar and radial fractures under brachial plexus nerve anesthesia with a BMI greater than 27 kg/m^2 were convenienty admitted to the department of orthopedics as study objects, and were divided into ultrasonic guidance group and blind exploration guidance group, which were respectively given ultrasonic guidance method and blind exploration guidance method. The operation effects(nerve block effect and times, etc.) of the two groups under anesthesia were statistically analyzed and observed.Results The excellent rate of block under ultrasound-guided brachial plexus anesthesia was 96.67%, which was higher than that of blind probe group(76.67%). The data comparison between groups was comparable, the difference was statistically significant(χ^2=6.397, P<0.05). In addition, the results of puncture times and adverse reactions were significantly better than those of conventional blind probing(P<0.05). Conclusion Four-point axillary nerve block can obviously improve the effect of brachial plexus anesthesia, increase the excellence of nerve block, reduce the number of punctures and reduce the occurrence of adverse reactions.