超声引导下连续肌间沟臂丛神经阻滞麻醉在不同类型上肢骨、折镇痛效果

Analgesic effect of continuous intermuscular groove brachial plexus block anesthesia under ultrasound guidance in different types of upper limb fractures

目的探讨超声引导下连续肌间沟臂丛神经阻滞麻醉在不同类型上肢骨折镇痛效果。方法择取2022年2月~2023年2月本院收治的行切开复位内固定术上肢骨折患者80例。按骨折不同类型分为尺桡骨骨折组(n=25例)、桡骨骨折组(n=28例)、肱骨骨折组(n=27例),均接受超声引导下连续肌间沟臂丛神经阻滞麻醉。比较三组镇痛、镇静效果及舒适度、炎性因子水平及不良反应发生率。结果T1~T4:三组NRS评分,(P<0.05),尺桡骨骨折组NRS评分高于桡骨骨折组及肱骨骨折组(P<0.05);使用次数:尺桡骨骨折组PCIA使用次数多于桡骨骨折组及肱骨骨折组(P<0.05);Ramsay镇静、BCS评分(P>0.05);三组T0时点IL-6、TNF-α水平比较,(P>0.05),与T0时点比较,三组T4时点IL-6、TNF-α水平更高,尺桡骨骨折组IL-6、TNF-α水平高于桡骨骨折组及肱骨骨折组(P<0.05);三组不良反应,(P>0.05)。结论超声引导下连续肌间沟臂丛神经阻滞麻醉适用于不同类型上肢骨折术后镇痛,以桡骨、肱骨骨折效果最好,但尺桡骨骨折效果一般,可能与炎性反应控制不足有关。

Objective To investigate the analgesic effect of continuous intermuscular groove brachial plexus block anesthesia guided by ultrasound in different types of upper limb fractures.Methods A total of 80 patients with upper limb fractures who underwent open reduction and internal fixation in our hospital from February 2022 to February 2023 were selected.According to different fracture types,they were divided into the ulnar and radius fracture group(n=25 cases),the radius fracture group(n=28 cases)and the humerus fracture group(n=27 cases).All of them received continuous ultrasound-guided brachial plexus block anesthesia.The analgesic effect,sedation and comfort,the level of inflammatory factors and the incidence of adverse reactions were compared among the three groups.Results T1-T4:NRS score of the three groups(P<0.05),the NRS score of the ulnar and radius fracture group was higher than that of the radius and humerus fracture groups(P<0.05);Use times:The use times of PCIA in radius fracture group were more than those in radius fracture group and humerus fracture group(P<0.05).Ramsay sedation,BCS score(P>0.05);The levels of IL-6 and TNF-α at T0 were higher in the three groups than those at T0(P>0.05).The levels of IL-6 and TNF-αat T4 were higher in the ulnar and radius fracture group than in the radius and humerus fracture groups(P<0.05).Three groups of adverse reactions(P>0.05).Conclusion Ultrasound-guided continuous intermuscular groove brachial plexus block anesthesia is suitable for postoperative analgesia of different types of upper limb fractures,with the best effect on radius and humerus fractures,but the effect on radius and ulnar fractures is not good,which may be related to inadequate control of inflammatory response.