桡骨远端手术B超引导下不同入路神经阻滞的效果

Effect of Different Approaches of Nerve Block Guided by B-ultrasound in Distal Radius Surgery

目的分析B超引导下腋路、肌间沟及锁骨上不同入路神经阻滞在桡骨远端手术中的应用效果。方法将我院收治的90例桡骨远端骨折患者随机分为A组、B组及C组,每组30例;A组采用肌间沟入路臂丛神经阻滞术治疗,B组采用腋路臂丛神经阻滞术治疗,C组采用锁骨上入路臂丛神经阻滞术治疗;观察三组患者操作时间及手术时间;统计所有患者痛觉消失时间,操作完成后采用针刺法对神经支配区痛觉进行评价;对患者各神经支配的感觉阻滞进行评价;分析患者局部麻醉药中毒、血肿、膈神经阻滞、术中止血带反应等并发症情况。结果三组操作时间及手术时间差异无统计学意义(P>0.05);三组患者前臂外侧皮神经及桡神经分支痛觉消失时间差异无统计学意义(P>0.05),B组患者前臂内侧皮神经、尺神经及正中神经分支痛觉消失时间低于A组及C组(P<0.05);B组患者麻醉效果优良率高于A组及C组(P<0.05);三组患者镇痛持续时间差异无统计学意义(P>0.05);三组患者并发症差异无统计学意义(P>0.05)。结论相较于前臂内侧皮神经、尺神经阻滞,腋路臂丛神经阻滞效果更好。

Objective To analyze the effect of axillary block,intermuscular groove and supraclavicular nerve block under the guidance of B-ultrasound in the operation of distal radius.Methods 90 cases of distal radius fractures treated were randomly divided into group A,group B and group C,30 cases in each group.Group A was treated with brachial plexus block with intermuscular ditches,group B was treated with axillary brachial plexus block,and group C was treated with supraclavicular brachial plexus block,and three groups of patients were observed.The time and time of operation were made;the time of disappearance of all the pain of all the patients was counted.After the operation was completed,the pain of the innervation area was evaluated by acupuncture;the sensory block of the innervation of the patients was evaluated;the complications of local anesthetic poisoning,hematoma,phrenic nerve block,and the discontinuation of blood band reaction were analyzed.Results There was no significant difference in the time and time of operation between the three groups(P>0.05).There was no significant difference between the three groups of the lateral forearm and radial nerve branches(P>0.05).The disappearance time of the medial forearm medial cutaneous nerve,the ulnar nerve and the median nerve branch in the B group was significantly lower than that of the group A and the C group(P<0.05);the patients in group B were in the B group.The good rate of anesthesia effect was higher than that of group A and group C(P<0.05);there was no significant difference in the duration of analgesia in the three groups(P>0.05),and there was no significant difference in the adverse reaction between the three groups(P>0.05).Conclusion Compared with forearm medial cutaneous nerve and ulnar nerve block,axillary brachial plexus block has better effect.