超声引导下颈浅丛联合锁胸筋膜平面阻滞在锁骨手术中的麻醉效果

Anesthetic effect of ultrasound-guided superficial cervical plexus combined with clavipectoral fascia plane block during clavicle surgery

目的:比较超声引导下颈浅丛联合锁胸筋膜平面阻滞在锁骨手术中的麻醉效果。方法:回顾性分析84例锁骨骨折患者的病历资料。按麻醉方式不同分为对照组(n=42,应用超声引导下颈浅丛联合肌间沟臂丛麻醉)和观察组(n=42,应用超声引导下颈浅丛联合锁胸筋膜平面阻滞),比较两组患者不同时段镇痛效果和术中体征、同侧膈肌麻痹发生率、阻滞相关指标、上肢运动阻滞评分及不良反应发生情况。结果:观察组患者不同时段VAS得分、术中心率和血压、同侧膈肌麻痹总发生率、阻滞操作时间、阻滞起效时间均低于对照组(P<0.05);术中血氧饱和度、镇痛持续时间高于对照组(P<0.05);观察组阻滞后4、8、12 h运动神经阻滞(Bromage)评分均低于对照组(P<0.05)。结论:超声引导下颈浅丛联合锁胸筋膜平面阻滞,更能提高锁骨骨折患者镇痛效果,维持术中体征稳定,减少同侧膈肌麻痹的发生率,保留同侧上肢的运动功能,且该区域麻醉技术操作简单,适合推广。

Objective:To compare the anesthetic effect of ultrasound-guided superficial cervical plexus combined with clavipectoral fascia plane block during clavicle surgery.Methods:84 patients with middle clavicle fractures were studied and divided into control group(n=42,ultrasound-guided superficial cervical plexus combined with interscalene brachial plexus anesthesia)and observation group(n=42,ultrasound-guided superficial cervical plexus combined with clavipectoral fascia plane block)according to different anesthesia methods.The analgesic effects and intraoperative signs,incidence rate of ipsilateral diaphragmatic paralysis,anesthesia-related indicators,upper limb motor block score and incidence rates of adverse reactions were compared between the two groups of patients at different time periods.Results:The VAS score,surgical center rate,blood pressure,total incidence of ipsilateral diaphragmatic paralysis,block operation time,and block onset time of the observation group were lower than those of the control group at different time periods(P<0.05).Intraoperative blood oxygen saturation and analgesic duration were higher in the control group than in the control group(P<0.05).The scores of motor nerve block(Bromage)in observation group at 4,8 and 12 h after recovery were lower compared with those in control group(P<0.05).Conclusion:Ultrasound-guided superficial cervical plexus combined with clavipectoral fascia plane block can enhance the anesthesia quality,reduce the incidence rate of ipsilateral diaphragmatic paralysis,and preserve the ipsilateral upper limb motor function in patients with middle clavicle fractures.The technique of regional anesthesia is simple and has clinical application value.