超声引导下神经阻滞用于锁骨骨折内固定术的效果观察

Anesthetic effect of ultrasound-guided nerve block for internal fixation of clavicle fractures

目的探讨在锁骨骨折内固定术过程中实施超声引导下臂丛神经阻滞复合颈浅丛神经阻滞的临床效果和安全性。方法以2019年6月至2022年3月于义乌市中心医院进行切开复位内固定术的锁骨骨折患者100例为研究对象,采用前瞻性随机对照研究方法,按照随机数字表法分为常规组(50例)和超声引导组(50例)。常规组通过盲探法实施臂丛神经阻滞复合颈浅丛神经阻滞,超声引导组在超声引导下实施臂丛神经阻滞复合颈浅丛神经阻滞。记录患者麻醉指标,监测术中生命体征指标,评价麻醉效果,观察麻醉不良反应。结果两组年龄、性别、ASA分级等一般资料比较,差异均无统计学意义(均P>0.05)。超声引导组麻醉操作时长和神经阻滞起效时间[(5.70±0.79)min和(7.28±0.90)min]均显著短于常规组[(12.18±1.03)min和(14.55±1.17)min](t=18.92、21.63,均P<0.001),而神经阻滞持续时间(417.84±13.88)min,显著长于常规组的(361.47±12.19)min(t=16.37,P<0.001);超声引导组切皮时和复位固定时平均动脉压和心率[(103.36±2.22)mmHg(1 mmHg=0.133 kPa)、(103.02±2.26)mmHg、(76.66±4.51)次/min和(75.94±4.34)次/min]显著低于常规组[(103.36±2.22)mmHg、(103.02±2.26)mmHg、(76.66±4.51)次/min和(75.94±4.34)次/min](t=6.83、5.52、6.27、4.96,均P<0.001);超声引导组麻醉有效率[94.00%(47/50)]显著高于常规组[76.00%(38/50)](χ^(2)=6.35,P<0.05);超声引导组麻醉不良反应发生率[4.00%(2/50)]显著低于常规组[20.00%(10/50)](χ^(2)=6.06,P<0.05)。结论超声引导下臂丛神经阻滞复合颈浅丛神经阻滞用于锁骨骨折内固定术,可有效缩短麻醉起效时间,降低患者术中生命体征波动,提高麻醉有效率,降低麻醉不良反应风险。

Objective To assess the clinical efficacy and safety of ultrasound-guided brachial plexus block combined with superficial cervical plexus block during the internal fixation of clavicle fractures.Methods A prospective randomized controlled study was conducted on 100 patients suffering from clavicular fractures who underwent open reduction and internal fixation at Yiwu Central Hospital between June 2019 and March 2022.Using a random number table method,the patients were divided into two groups:a conventional group(n=50)and an ultrasound-guided group(n=50).The conventional group received blind brachial plexus block combined with superficial cervical plexus block,while the ultrasound-guided group received brachial plexus block combined with superficial cervical plexus block under ultrasound guidance.The anesthesia indices of the patients were recorded,intraoperative vital signs were monitored,the anesthesia effect was evaluated,and adverse reactions to anesthesia were observed.Results There were no significant differences in general data between the two groups,including age,sex,and ASA grading(P>0.05).The duration of anesthesia operation and the onset time of nerve block in the ultrasound-guided group[(5.70±0.79)minutes and(7.28±0.90)minutes]were significantly shorter compared with the conventional group[(12.18±1.03)minutes and(14.55±1.17)minutes,t=18.92,21.63,both P<0.001].However,the duration of nerve block in the ultrasound-guided group was(417.84±13.88)minutes,which was significantly longer than that in the conventional group[(361.47±12.19)minutes,t=16.37,P<0.001].Additionally,the mean arterial pressure and heart rate in the ultrasound-guided group[(103.36±2.22)mmHg(1 mmHg=0.133 kPa),(103.02±2.26)mmHg,(76.66±4.51)beats/minute and(75.94±4.34)beats/minute]were significantly lower compared with the conventional group[(103.36±2.22)mmHg,(103.02±2.26)mmHg,(76.66±4.51)beats/minute,and(75.94±4.34)beats/minute,t=6.83,5.52,6.27,4.96,all P<0.001].Furthermore,the effective rate of anesthesia in the ultrasound-guided group was 94.00%(47/50),which was significantly higher than that in the conventional group[76.00%(38/50),χ^(2)=6.35,P<0.05].The overall incidence of adverse reactions to anesthesia in the ultrasound-guided group was 4.00%(2/50),which was significantly lower than that in the conventional group[20.00%(10/50),χ^(2)=6.06,P<0.05].Conclusion Ultrasound-guided brachial plexus block combined with superficial cervical plexus block for internal fixation of clavicular fractures can effectively shorten the onset time of anesthesia,minimize fluctuations in patients'intraoperative vital signs,improve the efficiency of anesthesia,and reduce the risk of adverse reactions.