超声引导不同入路的臂丛神经阻滞对肱骨骨折老年患者麻醉药物用量及应激反应的影响

Effects of Ultrasound-guided Brachial Plexus Blocks with Different Approaches on Anesthetic Drug Dosage and Stress Response in Elderly Patients with Humeral Fracture

目的探讨针对老年肱骨骨折的患者,采取经超声引导下的不同入路臂丛神经阻滞对麻醉药物用量及应激反应影响。方法纳入在2022年1月至2023年1月收治的老年肱骨骨折患者80例。根据麻醉方案不同分成颈动脉组40例(超声引导下臂丛神经阻滞经颈动脉入路)与锁骨后组40例(超声引导下臂丛神经阻滞经锁骨后入路),两组均是应用对应麻醉阻滞方案。对比两组的麻醉阻滞效果、术前与术后48h的应激反应[丙二醛(MDA)、超氧化物歧化酶(SOD)、S100β蛋白]、预后。结果颈动脉组在麻醉药物用量与麻醉起效时间指标均低于锁骨后组(P<0.05);两组在术前与术后48h的MDA、SOD、S100β蛋白水平改变,但是组间指标差异无统计学意义(P>0.05),两组Richer评分、痛泵按压次数的指标差异无统计学意义(P>0.05)。结论经超声引导下不同入路的臂丛神经阻滞方式干预老年肱骨骨折,采取颈动脉入路方式除了在麻醉药物用量与麻醉起效时间比锁骨后入路组更低,不同入路方式在应激反应影响以及预后方面的指标比较无显著差异。

Objective To investigate the effect of ultrasound-guided brachial plexus block on anesthetic drug dosage and stress response in elderly patients with humerus fracture.Methods A total of 80 elderly patients with humeral fracture admitted from January 2022 to January 2023 were included.According to different anesthesia schemes,40 cases were divided into carotid artery group(ultrasound-guided lower brachial plexus block transcarotid approach)and 40 cases in the retroclavian group(ultrasound-guided lower brachial plexus block transclavian approach),and the corresponding anesthesia block regimen was applied in both groups.The anesthesia blocking effect,stress response[malondialdehyde(MDA),superoxide dismutase(SOD),S100βprotein],and prognosis of the two groups were compared.Results The dosage of anesthetic drugs and the onset time of anesthesia in the carotid artery group were lower than those in the retroclavian group(P<0.05),and the levels of MDA,SOD and S100βprotein changed in the preoperative and postoperative 48 hours after the two groups,but there was no significant difference between the groups(P>0.05),and the difference in Richer score and pain pump compression times between the two groups was not significant(P>0.05).Conclusion In the intervention of brachial plexus block with different approaches under ultrasound guidance,the carotid approach was adopted in addition to the lower amount of anesthesia drugs and the onset time of anesthesia than the retroclavian approach,and there was no significant difference in the impact of stress response and prognosis of different approaches.