超声引导下颈丛C4横突阻滞一点法在锁骨骨折内固定术中的麻醉效果观察

Anesthetic effects of cervical plexus C4 transverse process block one⁃point method under ultrasound guidance in internal fixation of clavicle fracture

目的探讨超声引导下颈丛C4横突阻滞一点法在锁骨骨折内固定术中的麻醉效果。方法选取2019年10月至2021年10月宿迁市中医院锁骨骨折患者80例,按照随机数字表法分为对照组、试验组,各40例。对照组采用盲探下颈丛C4横突阻滞一点法进行麻醉,试验组采用超声引导下颈丛C4横突阻滞一点法进行麻醉。比较2组神经阻滞完成时间、手术时间,并对比2组麻醉前(T0)、手术切皮时(T1)、骨折复位时(T2)、手术缝皮时(T3)的血流动力学[心率(HR)、平均动脉压(MAP)]及镇痛效果[视觉模拟量表(VAS)评分],统计麻醉效果及麻醉相关不良反应。结果2组手术时间比较差异无统计学意义(P>0.05);试验组神经阻滞完成时间短于对照组(P<0.05)。2组不同组间、不同时间点、组间不同时间点HR、MAP水平比较差异均有统计学意义(P<0.05);T0时2组HR、MAP水平比较差异无统计学意义(P>0.05),T1、T2、T3时试验组HR、MAP水平低于对照组(P<0.05);对照组T1、T2、T3时HR、MAP水平高于T0(P<0.05),但试验组不同时间点HR、MAP水平比较差异无统计学意义(P>0.05)。2组不同组间、不同时间点、组间不同时间点VAS评分比较差异有统计学意义(P<0.05);T0时2组VAS评分比较差异无统计学意义(P>0.05),T1、T2、T3时试验组VAS评分均低于对照组(P<0.05);T1、T2、T3时2组VAS评分均低于T0(P<0.05)。试验组麻醉有效率为95.00%,对照组麻醉有效率为82.50%,差异有统计学意义(P<0.05)。2组膈神经阻滞、喉返神经阻滞、霍纳综合征发生率比较差异无统计学意义(P>0.05),试验组损伤血管发生率低于对照组(P<0.05)。结论超声引导下颈丛C4横突阻滞一点法应用于锁骨骨折内固定术能缩短神经阻滞完成时间,维持血流动力学稳定,改善镇痛效果,麻醉效果显著,且能减少血管损伤不良反应的发生。

Objective To study the anesthetic effects of cervical plexus C4 transverse process block one-point method under ultrasound guidance in internal fixation of clavicle fracture.Methods Eighty patients with clavicle fracture admitted to Suqian Traditional Chinese Medicine Hospital from October 2019 to October 2021 were randomly assigned(1∶1)to control group,or experimental group according to radom number table.The control group was anesthetized by cervical plexus C4 transverse process block one-point method with blind exploration,while the experimental group was anesthetized by cervical plexus C4 transverse process block one-point method under ultrasound guidance.The completion time of nerve block and surgical time were compared between the 2 groups.The hemodynamics(heart rate[HR],mean artery pressure[MVP]),and analgesic effects(visual analogue scale[VAS])before anesthesia(T0),during surgical skin incision(T1),fracture reduction(T2),and during surgical skin suture(T3)were also compared between the 2 groups.The anesthetic efficacy and anesthesia-related adverse reactions were statistically analyzed.Results There were no significant differences in surgical time between the 2 groups(P>0.05).The completion time of nerve block in the experimental group was significantly shorter than that in the control group(P<0.05).There were significant differences in the levels of HR and MAP at different time points of the 2 groups,when comparisons were made between the 2 groups(P<0.05).There were no significant differences in the levels of HR or MAP,when comparisons were made between the 2 groups at T0(P>0.05).The levels of HR and MAP in the experimental group at T1,T2,and T3 were significantly lower than those in the control group(P<0.05).The levels of HR and MAP at T1,T2,and T3 in the control group were significantly higher than those at T0(P<0.05).However,there were no significant differences in the levels of HR or MAP,when comparisons were made at different time points in the experience group(P>0.05).There were significant differences in VAS scores,when comparisons were made between different groups,at different time points,at different time points between groups(P<0.05).There were no significant differences in VAS scores,when comparisons were made between the 2 groups at T0(P>0.05).The VAS scores of the experimental group at T1,T2,and T3 were significantly lower than those of the control group(P<0.05),and the VAS scores of the 2 groups at T1,T2,and T3 were significant differences lower than those at T0(P<0.05).The effective anesthetic rate of the experimental group was 95.00%and that of the control group was 82.50%,with statistical significance,when comparisons were made between the 2 groups(P<0.05).There were no singificant differences in the incidences of phrenic nerve block,recurrent laryngeal nerve block,or Horner syndrome,when comparisons were made between the 2 groups(P>0.05).The incidence of vascular injury in the experience group was significantly lower than that in the control group(P<0.05).Conclusion The application of cervical plexus C4 transverse process block one-point method under ultrasound guidance in clavicular fracture internal fixation can shorten the completion time of nerve block,maintain hemodynamic stability,improve analgesic effect,with good anesthetic effects.Furthermore,it can reduce the incidence of adverse reactions of vascular injury.