超声引导下锁骨上臂丛神经阻滞在上肢骨折手术中的效果分析  

Effect of ultrasound guided supraclavicular brachial plexus block in upper extremity fracture surgery

作　　者：张宗余[1] 胡鹏[2] 芦智波 梁然 周志竞 张鹏[1] Zhang Zongyu;Hu Peng;Lu Zhibo;Liang Ran;Zhou Zhijing;Zhang Peng(Department of Orthopaedics,Lianyungang Hospital of Traditional Chinese Medicine Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine,Lianyungang 222000,China;Department of Anesthesiology,Lianyungang Hospital of Traditional Chinese Medicine Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine,Lianyungang 222000,China)

机构地区：[1]南京中医药大学连云港附属医院骨科,江苏连云港222000 [2]南京中医药大学连云港附属医院麻醉科,江苏连云港222000

出　　处：《中国临床实用医学》2020年第3期19-23,共5页China Clinical Practical Medicine

摘　　要：目的探讨超声引导下锁骨上臂丛神经阻滞在上肢骨折手术中的有效性与安全性,为临床麻醉提供参考依据。方法选取2019年1—12月南京中医药大学连云港附属医院骨科收治的120例上肢骨折患者,男71例,女49例,年龄(40.56±9.89)岁,年龄范围为22~64岁,采用随机数表法将患者随机分为传统方法组、神经仪刺激组和超声引导组,每组40例。三组患者分别采取针刺体表定位臂丛神经、神经刺激器定位臂丛神经、超声引导定位臂丛神经,比较三组患者的麻醉效果以及臂丛神经主要分支的阻滞起效时间、完全阻滞率。结果超声引导组尺神经[(6.47±2.09)min]、正中神经[(5.42±1.63)min]、肌皮神经[(4.67±1.79)min]和桡神经阻滞起效时间[(4.39±1.52)min]均明显低于传统方法组[(17.96±5.85)min、(16.04±4.89)min、(13.16±4.11)min、(14.72±4.76)min]和神经仪刺激组[(11.73±3.64)min、(10.56±3.17)min、(9.13±2.65)min、(8.57±2.28)min],神经仪刺激组均明显低于传统方法组,差异有统计学意义(P<0.05);超声引导组尺神经完全阻滞率[100%(40/40)]明显高于传统方法组[65.0%(26/40)]和神经仪刺激组[80.0%(32/40)],神经仪刺激组明显高于传统方法组;超声引导组和神经仪刺激组正中神经完全阻滞率[100%(40/40)、95.0%(38/40)]均明显高于传统方法组[77.5%(31/40)],差异有统计学意义(P<0.05);超声引导组麻醉优良率[100%(40/40)]明显高于传统方法组[72.5%(29/40)]和神经仪刺激组[90.0%(36/40)],神经仪刺激组明显高于传统方法组,差异有统计学意义(P<0.05)。三组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论在上肢骨折手术中,超声引导下锁骨上臂丛神经阻滞能够明显缩短麻醉起效时间,阻滞效果更加显著,且未增加并发症的发生,值得在临床上推广应用。Objective To investigate the efficacy and safety of supraclavicular brachial plexus nerve block under ultrasound guidance in upper extremity fracture surgery,and to provide reference for clinical anesthesia.Methods From January to December 2019,120 cases of patients with upper extremity fractures were admitted in Lianyungang Hospital of Traditional Chinese Medicine Affiliated Lianyungang Hospital of Nanjing University of Chinese Medicine,including 71 males and 49 females,aged(40.56±9.89)years old,ranging 22 to 64 years old.Patients were randomly divided into the traditional method group,the neurometer stimulation group and the ultrasound-guided group,with 40 cases in each group.Patients in the three groups were treated with acupuncture to locate brachial plexus nerve on body surface,nerve stimulator to locate brachial plexus nerve,and ultrasound guided to locate brachial plexus nerve,respectively,to compare the anesthetic effect of patients in the three groups,as well as the onset time and complete block rate of the main branches of brachial plexus nerve.Results The onset time of ulnar nerve[(6.47±2.09)minutes],median nerve[(5.42±1.63)minutes],musculocutaneous nerve[(4.67±1.79)minutes]and radial nerve block[(4.39±1.52)minutes]in the ultrasound guided group was significantly lower than that in the conventional method group[(17.96±5.85)minutes,(16.04±4.89)minutes,(13.16±4.11)minutes,(14.72±4.76)minutes],and the neurometer stimulation group[(11.73±3.64)minutes,(10.56±3.17)minutes,(9.13±2.65)minutes,(8.57±2.28)minutes],and the neurometer stimulation group were significantly lower than the traditional method group,with statistically significant differences(P<0.05).The rate of ulnar nerve complete block in the ultrasound guided group[100%(40/40)]was significantly higher than that in the conventional method group[65.0%(26/40)]and the neurometer stimulation group[80.0%(32/40)].The rates of median nerve complete block in the ultrasound guided group and the neurometer stimulation group[100%(40/40),95.0%(38/40)

关 键 词：上肢骨折 超声检查 神经传导阻滞 臂丛 麻醉 

分 类 号：R614[医药卫生—麻醉学]