角袋注射技术对锁骨上臂丛神经阻滞后膈肌麻痹的影响  

The effect of angular pocket injection technique on diaphragmatic paralysis after supraclavicular brachial plexus obstruction

作　　者：刘亚君[1] 张明哲 王国瑞 刘文平 吕瑞兆 井郁陌[1] LIU Ya-jun;ZHANG Ming-zhe;WANG Guo-rui;LIU Wen-ping;LV Rui-zhao;JING Yu-mo(Department of Anesthesiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, Cangzhou 061001, China;Department of Ultrasound, People's Hospital of Cangzhou City, Hebei Province, Cangzhou 061001, China)

机构地区：[1]河北省沧州中西医结合医院麻醉科,河北沧州061001 [2]河北省沧州市人民医院超声科,河北沧州061001

出　　处：《河北医科大学学报》2022年第4期470-475,共6页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题计划(20200609)。

摘　　要：目的探究角袋注射技术对锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)后膈肌麻痹的影响。方法选取行上肢骨折手术的患者40例,随机分为研究组和对照组,每组20例。两组均行SCBPB,研究组采用超声引导角袋注射技术,对照组采用神经丛周围阻滞麻醉。比较两组麻醉阻滞操作用时、阻滞效果评分、麻醉持续时间、各外周神经阻滞起效时间、阻滞后30 min不同呼吸状态下膈肌麻痹情况、不良反应发生率,并比较阻滞前、阻滞后30 min膈肌移动度、肺功能指标[第1秒用力呼气量(forced expiratory volume in first second,FEV_(1))、用力肺活量(forced vital capacity,FVC)]。结果研究组麻醉阻滞操作用时、阻滞效果评分、麻醉持续时间与对照组比较差异无统计学意义(P>0.05)。两组桡神经、正中神经、尺神经、肌皮神经、前臂内侧皮神经阻滞起效时间比较差异均无统计学意义(P>0.05)。阻滞后30 min,两组平静呼吸、用力呼吸状态下膈肌移动度均低于阻滞前,研究组高于对照组(P<0.05);两组FEV_(1)、FVC均低于阻滞前,研究组高于对照组(P<0.05)。研究组阻滞后30 min膈肌麻痹率低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论在保障有效麻醉阻滞效果的前提下,角袋注射技术能明显降低SCBPB膈肌麻痹发生率,改善患者肺功能指标,可为SCBPB提供新思路。Objective To explore the effect of horn pocket injection technique on diaphragmatic paralysis after supraclavicular brachial plexus block(SCBPB).Methods In total,40 patients who underwent upper limb fracture surgery in our hospital were selected,and randomly divided into a research group(n=20)and a control group(n=20).SCBPB was performed in both groups,the research group was given ultrasound-guided angle pocket injection technique,and the control group was given traditional plexus block anesthesia.The duration of operation of anesthesia block,the score of block effect,the duration of anesthesia,the onset time of each peripheral nerve block,diaphragmatic paralysis under different respiratory states and the incidence of adverse reactions were compared between two groups.Diaphragmatic movement and lung function indicators[forced expiratory volume in first second(FEV_(1)),forced vital capacity(FVC)]before and at 30 min after block were compared.Results There was no significant difference in duration of operation of anesthesia block,block effect score and anesthesia duration between research group and the control group(P>0.05).There was no significant difference in the onset time of radial nerve,median nerve,ulnar nerve,musculocutaneous nerve and medial forearm cutaneous nerve block between two groups(P>0.05).At 30 min after block,the diaphragmatic movement of the two groups in the state of calm breathing and forced breathing was lower than that before block,which was higher in the research group than in the control group(P<0.05).FEV_(1) and FVC in the two groups were lower than those before block,which were higher in the research group than in the control group(P<0.05).The rate of diaphragmatic paralysis at 30 min after block in the research group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Under the premise of ensuring the effective anesthesia block effect,the corner pocket injection technique can sig

关 键 词：骨折 角袋注射技术 锁骨上臂丛神经阻滞 

分 类 号：R683.41[医药卫生—骨科学]