肋锁入路连续臂丛神经阻滞在儿童上肢骨折麻醉中的应用  

Application of continuous brachial plexus block through intercostal approach in the anesthesia of upper limb fracture in children

作　　者：王辉[1] 王鲲 WANG Hui;WANG Kun(Department of Anesthesiology,Affiliated Hospital of Hanzhong Vocational and Technical College,Hanzhong,Shaanxi 723000,China;Department of Anesthesiology,Staff Hospital of Shaanxi Provincial Bureau of Geology and Mineral Exploration and Development,Xi′an,Shaanxi 710014,China)

机构地区：[1]汉中职业技术学院附属医院麻醉科,陕西汉中723000 [2]陕西省地质矿产勘查开发局职工医院麻醉科,陕西西安710014

出　　处：《检验医学与临床》2022年第6期787-790,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨肋锁入路连续臂丛神经阻滞在儿童上肢骨折麻醉中的应用效果。方法选取2018年1月至2020年1月于汉中职业技术学院附属医院接受上肢骨折手术治疗的100例患儿作为研究对象,按照麻醉方式的不同分为A组(行肋锁入路连续臂丛神经阻滞,50例)和B组(行喙突入路连续锁骨下臂丛神经阻滞,50例),比较两组患儿臂丛神经阻滞效果、注药后不同时间点运动感觉阻滞情况,以及静息视觉模拟评分(VAS评分)差异、麻醉后不良事件发生情况。结果A组患儿臂丛神经深度低于B组,阻滞操作时间短于B组,阻滞维持时间长于B组,差异均有统计学意义(P<0.05)。A组患儿注药后5、10 min时正中神经、尺神经、桡神经和肌皮神经感觉阻滞率均高于B组,差异均有统计学意义(P<0.05);A组患儿注药后10 min时尺神经和桡神经运动阻滞率均高于B组,差异均有统计学意义(P<0.05)。A组患儿术后12、18、24、36 h时静息VAS评分均少于B组,差异均有统计学意义(P<0.05)。A组患儿出现恶心呕吐等不良反应总发生率为2.00%,B组患儿不良反应总发生率为4.00%,两组患儿不良反应总发生率比较,差异无统计学意义(P>0.05)。结论对上肢骨折患儿实施肋锁入路连续臂丛神经阻滞能够发挥较好的麻醉阻滞效果,相比喙突入路连续锁骨下臂丛神经阻滞患儿感觉和运动阻滞更迅速,术后镇痛效果更好。Objective To explore the application effect of continuous brachial plexus block through intercostal approach in anesthesia of children with upper limb fracture.Methods A total of 100 children who underwent upper limb fracture surgery in Affiliated Hospital of Hanzhong Vocational and Technical College from January 2018 to January 2020 were selected as the research subjects.According to the difference of anesthesia methods,they were divided into group A(50 cases with continuous brachial plexus block through intercostal approach)and group B(50 cases with continuous subclavian brachial plexus block through coracoid approach).The effects of brachial plexus block,motor and sensory block at different time points after drug injection,differences in resting visual analogue scale score(VAS score),and adverse events after anesthesia were compared between the two groups.Results The depth of brachial plexus in group A was lower than that in group B,the operation time of block was shorter and the maintenance time of block was longer than those in group B,the differences were statistically significant(P<0.05).The sensory block rate of median nerve,ulnar nerve,radial nerve and musculocutaneous nerve in group A at 5 min and 10 min after injection was higher than those in group B,the differences were statistically significant(P<0.05).The motor block rate of ulnar nerve and radial nerve in group A at 10 min after injection were higher than those in group B,the differences were statistically significant(P<0.05).The resting VAS scores in group A at 12,18,24 h and 36 h after surgery were lower than those in group B,the differences were statistically significant(P<0.05).The total incidence of adverse reactions such as nausea and vomiting in group A was 2.00%,and the total incidence of adverse reactions in group B was 4.00%.There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The continuous brachial plexus block through intercostal approach in children with upper limb

关 键 词：肋锁入路连续臂丛神经阻滞 儿童上肢骨折 麻醉应用 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学] R683.41[医药卫生—外科学]