超声引导下锁骨上复合锁骨下臂丛神经阻滞对老年患者膈肌功能的影响

Effect of Ultrasound-Guided Supraclavicular Complex Subclavian Brachial Plexus Nerve Block on Diaphragmatic Function in Elderly Patients

目的:针对右侧上肢手术老年患者行超声引导下锁骨上复合锁骨下臂丛神经阻滞,观察患者膈肌功能变化情况。方法:选取我院接受右侧上肢手术的60例患者,年龄65~79岁,ASAⅡ~Ⅲ级并通过简单随机分为两组。S组(锁骨上臂丛神经阻滞组)行超声引导下锁骨上臂丛神经阻滞,注射0.33%的罗哌卡因30 mL;C组(锁骨上复合锁骨下臂丛神经阻滞组)在超声引导下先行锁骨上臂丛神经阻滞,注射0.33%的罗哌卡因10mL,后行锁骨下臂丛神经阻滞,注射0.33%的罗哌卡因20mL。对两组神经根感觉与运动阻滞时间进行观察记录,并组间对比,随访患者有无不良反应,判断类型,比较两组发生率的高低。对阻滞前后患者右侧膈肌移动幅度(平静呼吸与用力呼吸状态下)予以M型超声测量,并依据膈肌移动幅度对患者膈肌麻痹情况进行判断,对比两组膈肌麻痹程度。结果:研究中发现在运动阻滞起效时间方面,S组所需时间短于C组(P<0.05),而在感觉阻滞起效与持续时间、运动阻滞持续时间显示两组差异不大。但两组在阻滞后30min,当处于平静呼吸和深呼吸状态下,右侧膈肌麻痹率S组明显高于C组(P<0.05)。结论:超声引导下锁骨上复合锁骨下臂丛神经阻滞可以为老年上肢手术提供良好的麻醉同时降低同侧膈肌麻痹的发生率。

Objective:To observe the effect of ultrasound-guided supraclavicular with infraclavicular brachial plexus block on diaphragmatic function in the elderly.Methods:A total of sixty patients,scheduled for the right upper limb fracture,aged 65-79 years,falling into ASA physical statusⅡorⅢ,were selected and Simple randomly divided into two groups.Group S(ultrasound-guided supraclavicular brachial plexus block)received ultrasound-guided supraclavicular brachial plexus block with 0.33%ropivacaine 30ml;Group C(ultrasound-guided supraclavicular with infraclavicular brachial plexus block)received ultrasound-guided supraclavicular brachial plexus block with 0.33%ropivacaine 10ml,then received infraclavicular brachial plexus block with 0.33%ropivacaine 20ml.The hemi-diaphragmatic movement was measured by M-mode ultrasonography under a quiet and deep breathing test before the block procedure and 30min after the block.The sensory block of the main nerve roots of the brachial plexus,the onset time and duration of motor block were recorded and the occurrence of adverse reactions was observed.Results:The onset time of sensory block and maintaining time of sensory block or motor block had no statistical difference between the two groups.Compared with Group C,the onset time of motor block in Group S was significantly shorter(P<0.05).There was a statistically significant difference in the degree of diaphragm paralysis between the two groups under quiet(P<0.05)and deep(P<0.05)breathing tests 30min after the block。Conclusion:The combination of ultrasound-guided supraclavicular brachial plexus block with infraclavicular brachial plexus block can provide good anesthesia,decrease ipsilateral diaphragmatic paralysis,and is a reasonable clinical use for the right upper limb fracture in the elderly.