超声和神经刺激仪引导下肌间沟臂丛阻滞用于锁骨骨折的效果

Effect of ultrasound plus PNS-guided intermuscular sulcus brachial plexus block on clavicle fracture

目的探讨超声+神经刺激仪(PNS)引导下肌间沟臂丛阻滞在锁骨骨折手术治疗中的应用效果及对病人血清应激指标的影响。方法选取阳江市阳东区人民医院拟实施手术治疗的锁骨骨折病人100例(2017年6月至2018年11月)采用随机数字表法分为引导组和常规组各50例,引导组采用超声+PNS引导下肌间沟臂丛+颈浅丛神经阻滞麻醉、常规组采用传统一针法实施肌间沟臂丛+颈浅丛神经阻滞麻醉;对比两组的平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(SpO_2)变化,记录两组病人的感觉起效时间、镇痛维持时间、运动阻滞起效时间、运动阻滞维持时间,术前及术后12 h的血清去甲肾上腺素(NE)、皮质醇(Cor)、肾上腺素(E)水平变化及不良反应。结果引导组和常规组病人在T0~T3时刻的HR、MAP及SpO_2测定值变化趋势组间比较差异均不具有统计学意义(P>0.05);引导组和常规组病人在T1~T3时刻的HR、MAP及SpO_2测定值较本组T0时刻均呈现不同程度的降低(P<0.05);引导组病人的感觉起效时间(6.88±2.04)min、运动阻滞起效时间(13.8±3.5)min、运动阻滞维持时间(115.8±22.9)min均低于常规组病人(8.90±2.71)min、(17.3±4.8)min、(142.4±29.5)min(P<0.05),引导组病人的镇痛维持时间(426.8±58.1)min显著的长于常规组(369.0±50.2)min(P<0.05);术前,两组病人的血清NE、Cor、E水平差异无统计学意义(P>0.05);术后12 h,引导组病人的血清NE(101.8±20.6)ng/L、Cor(62.4±10.5)μg/L、E(472.0±148.2)nmol/L均低于常规组病人NE(130.2±28.1)ng/L、Cor(85.1±14.3)μg/L、E(605.8±180.5)nmol/L(P<0.05);引导组病人的麻醉相关并发症发生率4.00%低于常规组病人的18.00(P<0.05)。结论 PNS引导下肌间沟臂丛联合颈浅丛神经阻滞在锁骨骨折手术中应用有利于提高神经阻滞中的精准性,缩短麻醉阻滞起效时间、延长麻醉时间的同时减轻机体对手术产生的应激反应。

Objective To explore the effect of ultrasound plus PNS-guided intermuscular sulcus brachial plexus block on clavicle fracture and its influence on serum stress index.Methods A total of 100 patients with clavicle fractures(from June 2017 to November 2018) who were to be operated on from the People’s Hospital of Yangdong District,Yangjiang City were assigned into a guided group and a conventional group with 50 cases each by a random number table.The guided group received ultrasound+PNS-guided intermuscular sulcus brachial plexus+superficial cervical plexus nerve block,and the conventional group used traditional one-needle method to perform intermuscular sulcus brachial plexus+superficial cervical plexus block anesthesia.Mean artery pressure(MAP),heart rate(HR) and arterial oxygen saturation(SpO2) were compared between the two groups,and the sensory onset time,analgesic maintenance time,motor block onset time,motor block maintenance time,changes in serum noradrenaline(NE),cortisol(Cor),epinephrine(E) levels and adverse effects were recorded before and 12 h after surgery.Results There was no statistically significant difference in the trend of changes in HR,MAP and SpO2 measured values between the guided group and the conventional group at T0~T3(P>0.05).The measured values of HR,MAP and SpO2 of patients in the guided group and the conventional group at T1~T3 were lower than those of the groups at TO(P<0.05).The sensory onset time(6.88±2.04) min,motor block onset time(13.8±3.5) min,and motor block maintenance time(115.8±22.9) min in the guided group were lower than those in the routine group [(8.90±2.71) min,(17.3±4.8) min,(142.4±29.5)min;P<0.05].The analgesic maintenance time in the guided group(426.8±58.1) min was significantly longer than that in the conventional group(369.0±50.2) min(P<0.05).Before surgery,the differences in serum NE,Cor,and E levels of the two groups of patients were not statistically significant(P>0.05);Twelve hours after surgery,levels of the serum NE(101.8±20.6) ng/L,Cor(62.4±10.5) μg/L,E(472.0±148.2) nmol/L of the patients in the guided group were lower than those of the serum NE(130.2±28.1) ng/L,Cor(85.1±14.3)μg/L,E(605.8±180.5) nmol/L(P<0.05) of the patients in the conventional group.The incidence of anesthesia-related complications in the guided group was lower than that in the conventional group(4.00% vs 18.00%,P<0.05).Conclusion PNS-guided intermuscular sulcus brachial plexus combined with superficial cervical plexus nerve block in the operation of clavicle fracture is beneficial to improve the accuracy of nerve block,shorten the onset time of anesthesia block,extend the time of anesthesia,and reduce the body’s stress response to surgery.