超声引导下锁骨上臂丛神经阻滞在重症老年上肢骨折手术中的麻醉效果

Anesthesia effect of ultrasound-guided supraclavicular brachial plexus blockin the operation of severe elderly upper limb fracture

目的探讨超声引导下锁骨上臂丛神经阻滞在重症老年上肢骨折手术中的麻醉效果。方法回顾性分析我院骨科2018年6月至2020年6月收治的126例重症老年上肢骨折患者的临床资料,根据不同麻醉方法将其分为对照组(n=63)和研究组(n=63)。对照组在盲探下行锁骨上臂丛神经阻滞麻醉,研究组在超声引导下行锁骨上臂丛神经阻滞麻醉。比较两组麻醉效果。结果研究组的麻醉优良率高于对照组(P<0.05)。研究组的尺神经、桡神经、正中神经、肌皮神经的麻醉起效时间及麻醉完成时间均显著短于对照组,麻醉维持时间长于对照组(P<0.05)。研究组术后12、24、48 h的VAS评分均显著低于对照组(P<0.05)。研究组不良反应总发生率显著低于对照组(P<0.05)。结论超声引导下锁骨上臂丛神经阻滞可有效提高麻醉效果及术后镇痛效果,且不良反应少,对保证重症老年上肢骨折手术顺利进行及术后恢复具有积极意义。

Objective To investigate the anesthesia effect of ultrasound-guided supraclavicular brachial plexus block in the operation of severe elderly upper limb fracture.Methods The clinical data of 126 elderly patients with severe upper limb fracture admitted in orthopaedics department of our hospital from June 2018 to June 2020 were analyzed retrospectively.The patients were divided into control group(n=63)and study group(n=63)according to different anesthesia methods.The control group received supraclavicular brachial plexus block anesthesia under blind exploration,while the study group received supraclavicular brachial plexus block anesthesia under ultrasound guidance.The anesthetic effects of the two groups were compared.Results The excellent and good rate of anesthesia in the study group was higher than that in the control group(P<0.05).The anesthesia onset time of ulnar nerve,radial nerve,median nerve and musculocutaneous nerve and anesthesia completion time of the study group were significantly shorter than those of the control group,and the anesthesia maintenance time was longer than that of the control group(P<0.05).The VAS score of the study group at 12,24 and 48 h after operation were significantly lower than those of the control group(P<0.05).The total incidence of adverse reactions in the study group was significantly lower than that in the control group(P<0.05).Conclusion Ultrasound-guided supraclavicular brachial plexus block can effectively improve the anesthetic effect and postoperative analgesia effect,and has less adverse reactions,which has positive significance for ensuring the smooth operation and postoperative recovery of severe elderly upper limb fracture.