臂丛颈丛神经阻滞麻醉联合瑞芬太尼在锁骨骨折中的应用及对OAA/S评分、VAS评分的影响

The application of brachial plexus cervical plexus block anesthesia combined with remifentanil in clavicular fracture and the effects of OAA/S score and VAS score

目的:观察臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折手术的效果。方法:选取吉安市永丰县中医院2019年1月~2022年11月就诊的锁骨骨折患者140例为研究对象,按照收治的先后顺序随机分为试验组和对照组各70例,对照组予以臂丛颈丛神经阻滞麻醉,试验组在对照组基础上加用瑞芬太尼。记录两组麻醉前(T0)、臂丛颈丛神经阻滞麻醉后15 min(T1)、辅助用药后3 min(T2)、手术开始后5 min(T3)、手术开始后15 min(T4)、手术结束时(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO 2)。同时观察两组期间的不良反应以及血管活性药麻黄碱、阿托品、尼卡地平以及艾司洛尔的例数。比较两组患者麻醉满意度的差异。结果:对照组T2时血压降低、心率减慢均不明显,与T0比较差异无统计学意义(P>0.05)。试验组T3、T4时血压升高、心率增快明显,与T0和对照组比较差异有统计学意义(P<0.05)。试验组T2血压降低、心率减慢明显,与对照组和T0比较差异有统计学意义(P>0.05),随后趋于平稳。试验组血管活性药物尼卡地平以及艾司洛尔的例数少于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分(VAS)及镇痛效果满意率比较差异有统计学意义(P<0.05)。结论:臂丛颈丛神经阻滞麻醉联合瑞芬太尼用于锁骨骨折切开复位内固定手术,镇静镇痛效果确切,呼吸循环稳定,患者麻醉满意度高,是一种安全、有效的麻醉方法。

Objective To observe the effect of brachial plexus cervical plexus block anesthesia combined with remifentanil for clavicular fracture surgery.Method A total of 140 patients with clavicular fracture admitted to the hospital were selected as research object from January 2019 to November 2022,and were randomly divided into experimental group and control group according to the order of admission,with 70 cases in each group.The control group was given brachial plexus cervical plexus block anesthesia,and the experimental group was given remifentanil on the basis of the control group.The mean arterial pressure,heart rate and pulse oxygen saturation of the two groups were recorded before anesthesia(T0),15 min after brachial plexus cervical plexus block(T1),3 min after adjuvant administration(T2),5 min after surgery(T3),15 min after surgery(T4),and at the end of surgery(T5).The adverse reactions and the number of cases of the vasoactive drugs ephedrine,atropine,nicardipine and esmolol were observed in both groups.The difference of anesthesia satisfaction between the two groups was compared.Results In the control group,there was no significant decrease in blood pressure and heart rate at T2,and there was no significant difference compared with T0(P>0.05).Blood pressure and heart rate increased significantly in T3 and T4 of control group,and the difference was statistically significant compared with T0 and control group(P<0.05).The T2 blood pressure and heart rate decreased significantly in the experimental group,and the difference was statistically significant compared with the control group and T0(P>0.05),and then leveled off.The number of cases of the vasoactive drugs nicardipine and esmolol in the experimental group was less than that in the control group(P<0.05).There were statistically significant differences in VAS score and analgesic effect satisfaction rate between the two groups(P<0.05).Conclusion Brachial plexus cervical plexus block anesthesia combined with remifentanil for open reduction and internal fixation of clavicular fracture has definite sedative and analgesic effect,stable respiratory circulation and high satisfaction with anesthesia.It is a safe and effective anesthesia method.