超声引导不同入路的臂丛神经阻滞对老年肱骨骨折患者麻醉效果及应激反应的影响

Effects of ultrasound-guided brachial plexus block with different approaches on anesthesia effect and stress response in elderly patients with humeral fractures

目的探讨超声引导不同入路的臂丛神经阻滞对老年肱骨骨折患者麻醉效果及应激反应的影响。方法选取2020年1月至2023年3月收治的82例老年肱骨骨折患者为研究对象,根据不同入路方式将其分为A组和B组,各41例。A组采用超声引导下颈动脉入路臂丛神经阻滞麻醉,B组采用超声引导下锁骨后入路臂丛神经阻滞麻醉。比较两组的麻醉效果。结果两组的麻醉优良率比较,差异无统计学意义(P>0.05)。A组的阻滞起效时间短于B组(P<0.05);两组的麻醉用药剂量、麻醉完成时间、镇痛维持时间比较,差异无统计学意义(P>0.05)。术前(T_(0))、切皮时(T_(1))、术毕即刻(T_(2)),两组的心率(HR)、平均动脉压(MAP)比较,差异无统计学意义(P>0.05)。T_(0)、T_(1)、T_(2),两组的肾上腺素(E)、超氧化物歧化酶(SOD)水平比较,差异无统计学意义(P>0.05)。结论超声引导颈动脉入路臂丛神经阻滞与锁骨后入路臂丛神经阻滞对老年肱骨骨折患者的麻醉效果相近,血流动力学均较稳定,应激反应程度均较轻,但超声引导颈动脉入路臂丛神经阻滞的阻滞起效时间更短。

Objective To investigate the effects of ultrasound-guided brachial plexus block with different approaches on anesthesia effect and stress response in elderly patients with humeral fractures.Methods A total of 82 elderly patients with humeral fractures admitted from January 2020 to March 2023 were selected as the research objects.According to different approaches,the elderly patients were divided into group A and group B,with 41 cases in each group.The group A received ultrasound-guided brachial plexus block anesthesia via carotid artery approach,and the group B received ultrasound-guided brachial plexus block anesthesia via retroclavicular approach.The anesthetic effects of the two groups were compared.Results There was no significant difference in the excellent and good rate of anesthesia between the two groups(P>0.05).The onset time of block in the group A was shorter than that in the group B(P<0.05);there were no significant differences in the dosage of anesthesia,the completion time of anesthesia and the maintenance time of analgesia between the two groups(P>0.05).There were no significant differences in the heart rate(HR)and mean arterial pressure(MAP)between the two groups before operation(T_(0)),at skin incision(T_(1))and immediately after operation(T_(2))(P>0.05).There were no significant differences in the levels of epinephrine(E)and superoxide dismutase(SOD)between the two groups at T_(0),T_(1) and T_(2)(P>0.05).Conclusion Ultrasound-guided brachial plexus block via carotid artery approach and brachial plexus block via retroclavicular approach have similar anesthetic effects on elderly patients with humeral fractures,and with stable hemodynamics and the mild stress response.However,the ultrasound-guided brachial plexus block via carotid artery approach has shorter onset time of block.