超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中应用效果的随机对照研究  

Efficiency of ultrasound guided C5 combined with cervical plexus block versus high brachial plexus block in clavicle operation: a randomized controlled trial

作　　者：赵玲[1] 李静[1] 党旭云[1] 何爱萍[1] 黄涛[2] 孙甫[2] 赵晓光[2] 盛旭东[3] 

机构地区：[1]西安医学院第一附属医院麻醉科,西安710077 [2]西安医学院第一附属医院骨科,西安710077 [3]西安医学院第一附属医院神经外科,西安710077

出　　处：《第三军医大学学报》2018年第3期242-247,共6页Journal of Third Military Medical University

基　　金：陕西省教育厅面上项目(16JK1648)~~

摘　　要：目的比较超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中的应用效果。方法选择我院2016年2-11月骨科ASA分级Ⅰ~Ⅱ级拟在神经阻滞麻醉下接受锁骨手术的患者58例,按照随机数字表法分为两组进行随机对照研究:C5和颈浅丛联合阻滞组(A组,n=29)与高位臂丛神经阻滞组(B组,n=29)。超声引导下穿刺,针尖到达目标位置后,回抽无液体,注入局麻药。记录患者穿刺前(T0)、穿刺成功后10 min(T1)、30 min(T2)心率,平均动脉压;术中剥离骨膜时,手术后1、6 h对患者进行VAS评分,记录霍纳综合征并对各组在阻滞成功后进行麻醉效果评价。结果超声引导下C5和颈浅丛联合阻滞比高位肌间沟阻滞麻醉起效时间更短(P<0.05),阻滞维持时间更长(P<0.05),运动神经阻滞概率较低(P<0.05)。霍纳征发生率较高位臂丛神经阻滞组低(P<0.05)。剥离骨膜时及术后1、6 h高位臂丛神经阻患者VAS评分明显高于C5和颈浅丛联合阻滞组(P<0.05)。术中芬太尼用量及术后30 min对患者肺功能影响均较小(P<0.05),患者感觉比较满意(P<0.05)。结论锁骨骨折手术应用超声引导下C5和颈浅丛联合阻滞麻醉优于高位臂丛神经阻滞麻醉。Objective To observe the efficacy of ultrasound-guided C5 combined with cervical plexus block and high brachial plexus block in clavicle operation. Methods Fifty-eight cases undergoing selective upper limb surgery under brachial plexus block admitted in our orthopedic department from February to November 2016 were recruited in this study. They were at an American Society of Anesthesiologists （ASA） of Ⅰ to Ⅱ, and were randomly divided into C5 combined with cervical plexus block group （group A, n=29） and high brachial plexus block group （group B, n=29）. When ultrasound guided the needle reaching the target position and no liquid was withdrawn, the local anesthetic was injected. The heart rate and mean arterial pressure were recorded before successful puncture （T0）, and in 10 （T1） and 30 min （T2） after successfully puncture. Visual analogue scale （VAS） score was scored in 1 and 6 h after operation and the moment of stripping periosteum. Horner＇s syndrome was recorded, and the efficacy of anesthesia in the 2 groups was evaluated. Results The group A had shorter onset time of anesthesia （P〈0.05）, longer block duration （P〈0.05）, lower motor nerve block rate onset time （P〈0.05）, and lower incidence rate of Horner＇s syndrome when compared with group B. The VAS score was significantly lower in group B than the group A at the moment of stripping periosteum and in 1 and 6 h postoperatively （P〈0.05）. The fentanyl amount used during the operation and effect on the lung function in 30 min after operation were quite lower in the group A than group B （P〈0.05）. The patients in group A were more satisfied （P〈0.05）. Conclusion C5 combined with cervical plexus block under ultrasound guidance is a better option for anesthesia in clavicular fracture.

关 键 词：神经阻滞 麻醉 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614.4[医药卫生—诊断学]