锁胸筋膜联合颈浅丛阻滞在锁骨骨折手术的应用研究

Application Research of Combined Sternoclavicular Fascia and Superficial Cervical Plexus Block in Clavicle Fracture Surgery

目的本研究旨在观察锁胸筋膜联合颈浅丛阻滞对锁骨骨折手术患者术中及术后肌力和疼痛评分的影响。方法在锁骨骨折手术中,纳入基线匹配的50例单侧锁骨中段骨折患者,通过完全随机数字表法原则,将患者分成锁胸筋膜联合颈浅丛阻滞组26例与肌间沟臂丛联合颈浅丛神经阻滞组25例。基本操作主要是采用B超引导穿刺,使用0.375%罗哌卡因共38mL进行麻醉,肌间沟臂丛联合颈浅丛神经阻滞组经肌间沟臂丛神经阻滞30mL,锁胸筋膜联合颈浅丛阻滞组经锁胸筋膜阻滞内外侧各15mL,记录两组患者麻醉前(T1),麻醉后20min(T2),手术结束后(T3)的平均动脉血压(MAP)、心率(HR)、血氧饱和度(SPO2),采用针刺法评估T2感觉阻滞效果,应用肌力评分和视觉疼痛评分(VAS)对T3的肌力及术毕对整个手术过程疼痛进行分级。结果两组MAP、HR、SPO2、麻醉后20min的感觉阻滞效果、整体麻醉效果评价差异无统计学意义(P>0.05),锁胸筋膜联合颈浅丛阻滞能满足锁骨骨折手术的麻醉要求,且在术毕肌力明显优于肌间沟神经阻滞,差异有统计学意义(P<0.05)。结论肌间沟臂丛神经阻滞与锁胸筋膜平面阻滞应用于锁骨骨折手术的安全性和麻醉效果相似,锁胸筋膜联合颈浅丛阻滞能满足锁骨骨折手术麻醉需求的同时,保留上肢的运动能力。

Objective The aim of this study was to observe the effects of clavicular-thoracic fascia combined with superficial cervical plexus block on muscle strength and pain scores in patients undergoing clavicular fracture surgery.Methods 50 patients with unilateral midclavicular fracture who were matched at baseline were included in the clavicular fracture operation,and the patients were divided into the clavicothoracic fascia combined with superficial cervical plexus block group(26 cases)and the intermuscular groove brachial plexus combined with superficial cervical plexus block group(25 cases)by completely random number table method.The basic operations were mainly B-ultrasound guided puncture,and 0.375% ropivacaine was used for 38 ml anesthesia,the intermuscular sulcus brachial plexus combined with superficial cervical plexus block group was 30ml via intermuscular sulcus brachial plexus block group,and the interthoracic fascia combined with superficial cervical plexus block group was 15ml intralateral thoracic fascia block group.The mean arterial blood pressure(MAP),heart rate(HR)and blood oxygen saturation(SPO2)of the two groups were recorded before anesthesia(T1),20 min after anesthesia(T2)and after surgery(T3).The T2 sensory block effect was evaluated by acupuncture.Muscle strength and visual pain scale(VAS)were used to evaluate the muscle strength of T3 and the pain during the whole operation.Results There was no statistical difference between the two groups in MAP,HR,SPO2,and the evaluation of sensory block effect and overall anesthesia effect 20 min after anesthesia.Clavicular-thoracic fascia combined with superficial cervical plexus block could meet the anesthesia requirements for clavicular fracture surgery,and the muscle strength after surgery was significantly better than that of intermuscular sulcus nerve block,with statistical significance.Conclusion The safety and anesthetic effects of intermuscular brachial plexus block and clavicular-thoracic fascia plane block in clavicular fracture surgery are similar.Clavicular-thoracic fascia combined with superficial cervical plexus block can satisfy the anesthesia needs of clavicular fracture surgery while preserving the movement ability of the upper limb.