超声引导下臂丛神经阻滞对上肢手术患者血流动力学、疼痛的影响

Effects of ultrasound-guided brachial plexus block on hemodynamics and pain in patients after upper limb surgery

目的探讨超声引导下臂丛神经阻滞对上肢手术患者血流动力学、疼痛的影响。方法选择300例上肢骨折行手术治疗患者,其中男性176例,女性124例;年龄21~64岁,平均年龄39.12岁;美国麻醉医师协会(ASA)分级,Ⅰ级193例,Ⅱ级107例。按随机数表法分为2组,各150例。两组患者均接受臂丛神经阻滞麻醉,对照组采用传统解剖穿刺定位,研究组采用超声引导下穿刺定位。比较两组麻醉效果、不同时间点血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)]、疼痛指标[视觉模拟量表(VAS)评分]、炎症反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]的变化情况及不良反应发生情况。结果研究组感觉阻滞起效时间、运动阻滞起效时间、麻醉药物使用剂量均较对照组低[(4.34±1.62) min vs (6.84±2.03) min、(6.11±2.12) min vs (9.62±3.07) min、(25.96±4.25) mL vs (36.96±3.66) mL;t=9.973、9.288、6.267,P均<0.05];研究组T1、T2、T3时HR、MAP均低于对照组(tHR=25.988、35.406、9.689,tMAP=24.802、30.519、18.779,P <0.05);研究组术后6、12、24 h时VAS评分均低于对照组[(3.75±1.01)分vs (4.87±1.12)分、(3.02±0.85)分vs(3.86±0.97)分、(1.78±0.52)分vs(2.59±0.67)分;t=9.094、7.977、11.697,P <0.05];研究组术后24 h时血清IL-6、TNF-α水平均低于对照组[(55.36±8.67) ng/L vs (67.63±9.95) ng/L、(25.67±5.33) pg/mL vs (32.15±4.36) pg/mL;t=11.387、5.325,P <0.05];研究组不良反应发生率较对照组低(2.00%vs 8.00%;χ^(2)=5.684,P <0.05)。结论给予上肢手术患者超声引导下臂丛神经阻滞,麻醉起效时间短,血流动力学平稳,减轻患者疼痛,麻醉并发症少,患者舒适性高,值得进一步推广。

Objective To probe the effect of ultrasound-guided brachial plexus block on hemodynamics and pain in patients after upper limb surgery. Methods A total of 300 patients with upper limb fractures were enrolled, which included 176 males and 124 females, aged 21-64 years old with mean age of 39.12 years old. According to American Society of Anesthesiologists(ASA) classification, 193 cases were grade Ⅰ and 107 were grade Ⅱ. All of them were divided into 2 groups by digital random table method and received brachial plexus block anesthesia, control group(n = 150) performed traditional anatomical puncture positioning and study group(n = 150) performed ultrasound-guided puncture positioning. The anesthetic effect, hemodynamic indexes[heart rate(HR), mean arterial pressure(MAP), blood oxygen saturation(SpO2), pain index [visual analogue scale(VAS) score], inflammatory reaction index[interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)] at different time points and adverse reactions between 2 groups were compared. Results The onset time of sensory block, motor block and anesthetic dosage of study group were lower than those of control group[(4.34 ± 1.62) minutes vs(6.84 ± 2.03) minutes,(6.11 ± 2.12) minutes vs(9.62 ± 3.07) minutes,(25.96 ± 4.25) minutes vs(36.96 ± 3.66) minutes;t = 9.973, 9.288, 6.267, P < 0.05];The HR and MAP of study group at T1, T2 and T3 were lower than those of control group(tHR= 25.988, 35.406, 9.689, tMAP= 24.802, 30.519,18.779, P < 0.05);the VAS scores of 6-hour, 12-hour and 24-hour post-surgery in study group were lower than those of control group[(3.75 ± 1.01) scores vs(4.87 ± 1.12) scores,(3.02 ± 0.85) scores vs(3.86 ± 0.97) scores,(1.78 ± 0.52) scores vs(2.59 ± 0.67) scores;t = 9.094, 7.977, 11.697, P < 0.05];the serum levels of IL-6 and TNF-α at 24-hour of study group were lower than those of control group[(55.36 ± 8.67) ng/L vs(67.63 ± 9.95) ng/L,(25.67 ± 5.33) pg/mL vs(32.15 ± 4.36) pg/mL;t =11.387, 5.325, P < 0.05]. The incidence of adverse reactions of study group was lower than that of control group(2.00 % vs 8.00 %;χ^(2)= 5.684, P < 0.05). Conclusion It is demonstrated that ultrasound-guided brachial plexus block for patients undergoing upper limb surgery showed short onset time of anesthesia, which could ensure stable hemodynamics with relieve pain, fewer complications and high comfort, it is worthy of further promotion.