神经刺激器联合超声引导肌间沟臂丛神经阻滞在儿童肱骨髁上骨折术中麻醉效果的研究

Study on the anesthesia effect of nerve stimulator combined with ultrasound-guided interosseous groove brachial plexus nerve block in children with supracondylar humerus fracture

目的探讨神经刺激器联合超声引导下肌间沟臂丛神经阻滞在儿童肱骨髁上骨折手术中的麻醉效果研究。方法选取2020年8月至2022年12月于金华市妇幼保健院手术治疗的58例肱骨髁上骨折患儿进行回顾性研究。根据术中肌间沟臂丛神经阻滞方式的差异分为观察组(神经刺激器联合超声引导下)、对照组(单纯神经刺激器定位下),每组各29例患儿。比较两组麻醉效果和一次穿刺成功率;神经阻滞30 min后的血流动力学指标;术后3、12、24、48 h的VAS评分;术后并发症发生率。结果两组患者一般资料比较无差异(P>0.05),具有可比性。观察组的麻醉优良率为93.10%(27/29,例)显著高于对照组的75.86%(22/29);一次穿刺成功率为96.55%(28/29,例)同样优于对照组的89.66%(26/29),差异存在统计学意义(P<0.05)。神经阻滞30 min后的血流动力学指标方面,观察组在EDV、PI、RI、TAMAX、Q等指标的改善均优于对照组(P<0.05),而在PSV上两组比较无差异(P>0.05)。术后各时间点VAS评分比较上,观察组在术后各时间点均低于对照组,差异存在统计学意义(P<0.05)。两组术后并发症发生率比较上,观察组为6.90%(2/29,例)与对照组的13.80%(4/29,例)比较,差异不存在统计学意义(P>0.05)。结论神经刺激器联合超声引导下肌间沟臂丛神经阻滞在儿童肱骨髁上骨折治疗中具有较好的麻醉效果,不仅可有效改善上肢血液循环及术后镇痛效果,还可以显著降低术后并发症的发生。

Objective A study to investigate the clinical effectiveness of nerve stimulator combined with ultrasound-guided interosseous groove brachial plexus nerve block in children with supracondylar humerus fractures.Methods 58 children with supracondylar humerus fractures treated surgically in our hospital from August 2020 to December 2022 were selected for a retrospective study.According to the difference of intraoperative interosseous groove brachial plexus nerve block method,the patients were divided into observation group(nerve stimulator combined with ultrasound guidance)and control group(under nerve stimulator positioning alone),29 children in each group.The anesthetic effect and the success rate of one puncture,the hemodynamic indexes after 30 min of nerve block,the VAS scores at 3,12,24 and 48h postoperatively,and the incidence of postoperative complications were compared between the two groups.Results There was no difference in the general data between the two groups(P>0.05),which was comparable.The excellent anesthesia rate of the observation group was 93.10%significantly higher than that of the control group(75.86%).The success rate of one puncture was 96.55%similarly better than that of the control group(89.66%),and the difference was statistically significant(P<0.05).In terms of hemodynamic parameters 30 min after nerve block,the observation group showed better improvement in EDV,PI,RI,TAMAX and Q than the control group(P<0.05),while there was no difference in PSV between the two groups(P>0.05).In the comparison of VAS scores at all postoperative time points,the observation group was lower than the control group at all postoperative time points,and the difference was statistically significant(P<0.05).When comparing the incidence of postoperative complications between the two groups,the difference was not statistically significant(P>0.05)when comparing the incidence of 6.90%in the observation group with 13.80%in the control group.Conclusion The nerve stimulator combined with ultrasound-guided brachial plexus nerve block in the interosseous sulcus has a good anesthetic effect in the treatment of supracondylar fractures of the humerus in children,which not only effectively improves blood circulation and postoperative analgesia in the upper limbs,but also significantly reduces the occurrence of postoperative complications.