超声引导下不同入路臂丛神经阻滞对老年肱骨骨折患者的影响  

Effect of different approach ultrasound-guided brachial plexus nerve block on elderly patients with humeral fractures

作　　者：何涛[1] 邓文芸 尹洁 何纬新 He Tao;Deng Wenyun;Yin Jie;He Weixin(Department of Anesthesiology,Kunming Hospital of Traditional Chinese Medicine,Yunnan Kunming 650011,China)

机构地区：[1]昆明市中医医院麻醉科,云南昆明650011

出　　处：《中国医刊》2023年第8期866-870,共5页Chinese Journal of Medicine

基　　金：云南省科技厅科技计划项目(202001BA070023-0044)。

摘　　要：目的探讨超声引导下不同入路臂丛神经阻滞对老年肱骨骨折患者的影响。方法选取2019年7月至2021年7月昆明市中医医院收治的114例老年肱骨骨折患者为研究对象,采用随机数字表法将研究对象分为腋窝组(超声引导下腋窝入路臂丛神经阻滞)、锁骨组(超声引导下锁骨入路臂丛神经阻滞)和肌间沟组(超声引导下肌间沟入路臂丛神经阻滞),每组38例。比较分析三组患者的麻醉效果,进入手术室时(T_(0))、麻醉阻滞时(T_(1))、切皮时(T_(2))、术后30min(T_(3))、术毕(T_(4))的血流动力学指标[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]和脑氧饱和度(regional cerebral oxygen saturation,rSO_(2)),手术前后的疼痛程度和认知功能[视觉模拟评分法(visual analogue score,VAS)评分、简易精神状态量表(mini-mental state examination,MMSE)评分],以及术后不良反应发生情况。结果肌间沟组患者的感觉阻滞起效时间、运动阻滞起效时间均显著短于腋窝组和锁骨组(P<0.05),感觉阻滞持续时间、运动阻滞持续时间均显著长于腋窝组和锁骨组(P<0.05)。T_(2)、T_(3)、T_(4)时刻,肌间沟组患者的HR、MAP均显著低于腋窝组和锁骨组(P<0.05),rSO_(2)均显著高于腋窝组和锁骨组(P<0.05)。术后12、24、48h,肌间沟组患者的VAS评分均显著低于腋窝组和锁骨组(P<0.05),MMSE评分均显著高于腋窝组和锁骨组(P<0.05)。三组患者的术后不良反应总发生率比较差异均无显著性(P>0.05)。结论超声引导下肌间沟入路臂丛神经阻滞可维持老年肱骨骨折患者的血流动力学水平稳定和脑氧供需平衡,明显减轻患者术后疼痛,对认知功能的影响较小,且安全性较好。Objective To investigate the effect of different approach ultrasound-guided brachial plexus nerve block(BPNB)on elderly patients with humeral fractures.Method 114 elderly patients with humerus fracture admitted to Kunming Hospital of Traditional Chinese Medicine from July 2019 to July 2021 were selected as the study objects.They were divided into axillary group(BPNB with axillary approach),clavicular group(BPNB with clavicular approach)and intermuscular groove group(BPNB with intermuscular groove approach)by random number table method,with 38 cases in each group.The anesthesia effects,hemodynamic index(HR,MAP,rSO_(2))at the time of room admission(T_(0)),during anesthetic block(T_(1)),at the time of skin incision(T_(2)),30min after surgery(T_(3)),at the end of surgery(T_(4)),pain level(VAS score)and cognitive function(MMSE score)before and after surgery,and postoperative adverse reactions of the three groups were compared and analyzed.Result The onset time of sensory block and motor block in intermuscular groove group were significantly shorter than those in axillary group and clavicular group(P<0.05),and the duration of sensory block and motor block were significantly longer than those in axillary group and clavicular group(P<0.05).At T_(2),T_(3) and T_(4),HR and MAP in intermuscular groove group were significantly lower than those in axillary group and clavicular group(P<0.05),and rSO_(2) was significantly higher than that in axillary group and clavicular group(P<0.05).At 12,24 and 48h after surgery,VAS scores in intermuscular groove group were significantly lower than those in axillary group and clavicular group(P<0.05),and MMSE scores were significantly higher than those in axillary group and clavicular group(P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions among the three groups(P>0.05).Conclusion Ultrasound-guided BPNB with intermuscular groove approach can maintain the stability of hemodynamic level,the balance of cerebral oxygen supply and demand,and sig

关 键 词：肱骨骨折 臂丛神经阻滞 腋窝入路 锁骨入路 肌间沟入路 

分 类 号：R614[医药卫生—麻醉学]