超声引导下两种神经阻滞在锁骨手术麻醉期间的应用对比  

Comparison of ultrasound-guided two nerve blocks during anesthesia of clavicle surgery

作　　者：陈韬 王胜斌[1] 居霞[1] 胡胜红[1] 徐四七[1] Chen Tao;Wang Shengbin;Ju Xia(Department of Anesthesiology,Anqing Municipal Hospital,Anqing,Anhui 246000,China)

机构地区：[1]安庆市立医院麻醉科

出　　处：《中华保健医学杂志》2020年第1期69-72,共4页Chinese Journal of Health Care and Medicine

摘　　要：目的比较超声引导下臂丛神经(C5)和颈浅丛联合阻滞、高位臂丛神经阻滞方式在锁骨手术中的麻醉应用效果。方法选取2016年10月~2019年5月安庆市立医院行神经阻滞麻醉下锁骨手术的患者60例,随机数表法分为对照组和观察组各30例,对照组采用超声引导下高位臂丛神经阻滞,观察组采用超声引导下C5和颈浅丛联合阻滞。比较两组麻醉效果、麻醉期间生命体征变化、疼痛视觉模拟评分、满意度评分及并发症。结果在锁骨外侧缘、锁骨中点、锁骨内侧缘区域,观察组痛觉消失时间均短于对照组,差异有统计学意义(P <0.05)。观察组总体镇痛时间长于对照组,差异有统计学意义(P <0.05)。麻醉10 min(T1)、麻醉60 min(T2)、手术结束(T3)时,观察组心率、收缩压、舒张压均低于对照组,差异有统计学意义(P <0.05)。观察组患者术中、术后3 h的疼痛评分均小于对照组,差异有统计学意义(P <0.05)。观察组满意度评分高于对照组,差异有统计学意义(P <0.05)。观察组发生皮下血肿1例;对照组发生皮下血肿2例,Hornor综合征1例。结论相比高位臂丛神经阻滞,锁骨手术采用C5和颈浅丛联合阻滞麻醉效果更好,镇痛起效快,镇痛时间长,心率血压波动小,并发症更少,更具优势。Objective To compare the anesthetic effects of ultrasound-guided C5 and superficial cervical plexus block and high brachial plexus block in anesthesia of clavicle surgery.Methods Sixty patients undergoing clavicular surgery under nerve block anesthesia in the hospital from October 2016 to May 2019 were randomly divided into control group and observation group,30 cases in each group.The control group was treated with ultrasound-guided high brachial plexus block while the observation group was treated with ultrasound-guided C5 and superficial cervical plexus block.The anesthetic effects,changes in vital signs during anesthesia,visual analogue scale of pain,satisfaction scores,and complications were compared between the two groups.Results At the lateral border of the clavicle,the midpoint of the clavicle,and the medial margin of the clavicle,the disappearance time of pain was shorter in the observation group than in the control group(P < 0.05).The overall analgesic time of the observation group was longer than that of the control group(P < 0.05).Heart rate,systolic blood pressure and diastolic blood pressure of the observation group after 10 min of anesthesia(T1),after 60 min of anesthesia(T2)and at the end of surgery(T3)were lower than those of the control group(P < 0.05).Pain scores of the observation group during operation and at 3 h after operation were lower than those of the control group(P < 0.05).The satisfaction score of the observation group was higher than that of the control group(P < 0.05).There was1 case with subcutaneous hematoma in the observation group,2 cases with subcutaneous hematoma and 1 case with Hornor syndrome in the control group.Conclusion Compared with high brachial plexus block,the anesthetic effect of C5 and superficial cervical plexus combined block is better in anesthesia of clavicle surgery.The analgesic method can work fast and last for a long time,with few fluctuations of heart rate and blood pressure,fewer complications and more advantages.

关 键 词：锁骨手术 神经阻滞麻醉 臂丛神经阻滞 颈丛神经阻滞 超声 

分 类 号：R614.4[医药卫生—麻醉学]