超声引导不同入路的臂丛神经阻滞对肱骨骨折老年患者麻醉药物用量及应激反应的影响

Effects of brachial plexus block with different approaches guided by ultrasound on the dosage of anesthetics and stress response in elderly patients with humeral fractures

目的探究超声引导不同入路的臂丛神经阻滞(BPB)对肱骨骨折老年患者麻醉药物用量及应激反应的影响。方法回顾性选取2019年3月至2021年10月合肥市第二人民医院收治的单侧肱骨近端骨折的老年患者81例,按照麻醉方案不同将其分为BPB阻滞A组(超声引导下臂丛神经阻滞麻醉,颈动脉入路)27例、BPB阻滞B组(超声引导下臂丛神经阻滞麻醉,锁骨后入路)27例和对照组(全身麻醉)27例。观察超声引导不同入路的臂丛神经阻滞和全身麻醉患者应激反应、预后状况等指标;比较手术前(T0)、切皮(T1)、拔管(T2)3个时间点患者生命体征指标。结果(1)BPB阻滞A组患者麻醉起效时间为(5.7±1.1)min,显著短于BPB阻滞B组[(8.8±1.4)min],差异有统计学意义(P<0.05)。(2)术后48 h,BPB阻滞组患者的丙二醛和中枢神经特异蛋白S100-β显著低于对照组,超氧化物歧化酶(SOD)值显著显著高于对照组,差异均有统计学意义(P<0.05)。治疗前后BPB阻滞A组和B组以上指标差异均无统计学意义(P>0.05)。(3)T0时两组患者生命体征差异无统计学意义(P>0.05);T1时,2个BPB阻滞组患者的心率显著低于对照组,BIS值显著高于对照组,差异均有统计学意义(P<0.05),平均动脉压值差异无统计学意义(P>0.05);T2时,2个BPB阻滞组患者的BIS值明显高于对照组,差异有统计学意义(P<0.05),心率和平均动脉压值差异无统计学意义(P>0.05)。治疗前后BPB阻滞A组和BPB阻滞B组以上指标差异均无统计学意义(P>0.05)。(4)与对照组相比,2个BPB阻滞组患者术后恶心/呕吐次数和镇痛泵按压次数显著性均显著减少,差异均有统计学意义(P<0.05),Richer评分差异无统计学意义(P>0.05),而BPB阻滞A组与BPB阻滞B组间以上指标差异无统计学意义(P>0.05)。结论相较于常规全身麻醉,超声引导下BPB对肱骨骨折老年患者应激反应影响较小,并保持麻醉术中患者生命体征更为稳定,且不适症状发生频次较低。但颈动脉入路BPB除了起效时间较短外,其余指标与锁骨后入路BPB相比无显著优势。

Objective To explore the effects of ultrasound-guided brachial plexus block(BPB)with different approaches on the dosage of anesthetics and stress response in elderly patients with humeral fractures.Methods Eighty-one elderly patients with unilateral proximal humeral fractures who admitted to Hefei Second People's Hospital from November 2019 to October 2021 were retrospectively divided into BPB block group A(ultrasound-guided brachial plexus block anesthesia,carotid artery approach)27 cases,BPB block group B(ultrasound-guided brachial plexus block anesthesia,retroclavicular approach)27 cases and control group(general anesthesia)27 cases according to the anesthesia plan.The stress response and prognosis of patients with brachial plexus block and general anesthesia guided by different approaches were observed;The vital signs of patients were compared at 3 time points before surgery(T0),skin incision(T1),and extubation(T2).Results(1)The onset time of anesthesia in BPB block group A was(5.7±1.1)min,which was significantly shorter than that in BPB block group B[(8.8±1.4)min],and the difference was statistically significant(P<0.05).(2)At 48 h after operation,the level of malondialdehyde and CNS-specific protein S100-βin the BPB block group were significantly lower than those in the general anesthesia control group,the level of superoxide dismutase(SOD)was significantly higher than that in the general anesthesia control group,and the differences were statistically significant(P<0.05).There was no significant difference in the above indexes between BPB block group A and group B before and after treatment(P>0.05).(3)There was no significant difference in vital signs between the two groups at T0(P>0.05);At T1,the HR of the BPB block group was significantly lower than that in the general anesthesia control group,the BIS value was significantly higher than that in the general anesthesia control group,and the differences were statistically significant(P<0.05),and there was no significant difference in MAP value(P>0.05);At T2,the BIS value of patients in the BPB block group was significantly higher than that of the control group,and the differences were statistically significant(P<0.05),and there was no significant difference in HR and MAP values(P>0.05).There was no significant difference in the above indexes between BPB block group A and group B before and after treatment(P>0.05).(4)Compared with the general anesthesia control group,the number of nausea/vomiting and the number of analgesic pump compressions were significantly reduced in the BPB block group after surgery,and the differences were statistically significant(P<0.05),the difference in Richer score was not statistically significant(P>0.05).There was no significant difference between group A and group B(P>0.05).Conclusion Compared with conventional general anesthesia,ultrasound-guided BPB has less effect on the stress response of elderly patients with humeral fracture,and keeps the vital signs of patients more stable during anesthesia,and the frequency of uncomfortable symptoms is lower.However,except for the shorter onset time of carotid artery approach BPB,other indicators have no significant advantages compared with retroclavicular approach BPB.