臂丛神经阻滞复合静脉全麻进行锁骨骨折手术对患者疼痛阈值和术后谵妄的影响  

Effect of Brachial Plexus Block Combined with Intravenous General Anesthesia on Pain Threshold and Postoperative Delirium in Patients Undergoing Clavicular Fracture Surgery

作　　者：李晴 张宇 张河 薛华 张浩 LI Qing;ZHANG Yu;ZHANG He;XUE Hua;ZHANG Hao(Department of Surgical Anesthesia,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China;Department of Anesthesia,Cancer Hospital Chinese Academy Of Medical Sciences,Beijing,100021,China;Department of Orthopedics,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China)

机构地区：[1]北京市昌平区中西医结合医院手术麻醉科,北京102208 [2]中国医学科学院肿瘤医院麻醉科,北京100021 [3]北京市昌平区中西医结合医院骨科,北京102208

出　　处：《现代生物医学进展》2022年第11期2161-2165,共5页Progress in Modern Biomedicine

基　　金：国家卫生计生委医药卫生科技发展项目(W2014ZT009)。

摘　　要：目的:探讨臂丛神经阻滞复合静脉全麻进行锁骨骨折手术对患者疼痛阈值和术后谵妄的影响。方法:选取本院2018年4月-2021年5月收治的100例锁骨骨折患者作为研究对象,随机将其分为观察组(n=50)和对照组(n=50)。观察组采用臂丛神经阻滞复合静脉全麻进行手术,对照组单独采用静脉全麻进行手术,对比两组患者手术时间、住院时间以及唤醒时间;不同时间生命体征;麻醉效果和术后疼痛阈值;术后谵妄发生率、谵妄持续时间以及每天睡眠时间。结果:观察组患者的术后住院时长以及唤醒时间明显低于对照组(P<0.05)。观察组T_(1)到T_(4)时间血氧饱和度(SPO_(2))、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)无明显波动,对照组T_(1)到T_(4)时间上述指标波动明显,且两组患者T_(2)、T_(3)时间SPO_(2)、SBP、DBP、MAP、HR对比差异显著(P<0.05);观察组患者的COR、NE在T_(2)、T_(3)明显下降,而对照组的COR在T_(2)、T_(3)呈上升趋势(P<0.05)。观察组运动神经阻滞时间以及感觉神经阻滞时间明显高于对照组(P<0.05),术后2 h、12 h、24 h疼痛阈值明显低于对照组(P<0.05)。观察组术后谵妄发生率和谵妄持续时间明显低于对照组(P<0.05)。结论:对锁骨骨折手术患者进行臂丛神经阻滞复合静脉全麻,有效降低患者手术时间、住院时间以及唤醒时间,同时稳定患者生命体征,提升麻醉效果,降低术后疼痛阈,并且谵妄发生率、谵妄持续时间以及每天睡眠时间相对较低。Objective:To investigate the effect of brachial plexus block combined with intravenous general anesthesia on pain threshold and postoperative delirium in patients with clavicular fracture.Methods:100 patients with clavicular fracture treated in our hospital from April 2018 to may 2021 were randomly divided into observation group(n=50)and control group(n=50).The observation group was operated by brachial plexus block combined with intravenous general anesthesia,and the control group was operated by intravenous general anesthesia alone.The operation time,hospital stay and wake-up time of the two groups were compared;Vital signs at different times;Anesthetic effect and postoperative pain threshold;Postoperative delirium incidence,delirium duration and daily sleep time.Results:The length of postoperative hospital stay and wake-up time in the observation group were lower than those in the control group(P<0.05).There were no significant fluctuations in blood oxygen saturation(SpO_(2)),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(map)and heart rate(HR)in the observation group from T_(1)to T_(4).The above indexes fluctuated significantly in the control group from T_(1) to T_(4),and there were differences in SpO_(2),SBP,DBP,map and HR between the two groups at T_(2)and T_(3)(P<0.05);Cor and NE in the observation group decreased significantly in T_(2)and T_(3),while cor in the control group increased in T_(2)and T_(3)(P<0.05).The motor nerve block time and sensory nerve block time in the observation group were higher than those in the control group(P<0.05),and the pain thresholds at 2 h,12 h and 24 h after operation were lower than those in the control group(P<0.05).The incidence and duration of postoperative delirium in the observation group were lower than those in the control group(P<0.05).Conclusion:Brachial plexus block combined with intravenous general anesthesia for patients undergoing clavicular fracture surgery can effectively reduce the operation time,hospital stay and wake-up

关 键 词：臂丛神经阻滞 静脉全麻 锁骨骨折手术 疼痛阈值 术后谵妄 

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