超声引导锁胸筋膜平面阻滞联合锁骨上神经阻滞在锁骨中段骨折手术中的临床应用效果  

Clinical application effect of ultrasound-guided clavipectoral fascial plane block combined with supraclavicular nerve block in midclavicular fracture surgery

作　　者：胡小福 张卫军 官海燕 HU Xiao-fu;ZHANG Wei-jun;GUAN Hai-yan(Wengyuan People's Hospital,Shaoguan 512600,China)

机构地区：[1]翁源县人民医院,广东韶关512600

出　　处：《医师在线》2024年第10期67-71,共5页Journal of Doctors Online

摘　　要：目的评估超声引导下锁胸筋膜平面阻滞(Clavipectoral fascial plane block,CPB)联合锁骨上神经阻滞(Supraclavicular nerve block,SCNB)在锁骨中段骨折手术中的应用优势。方法选取锁骨中段骨折内固定术患者60例,采用随机数字表法分为两组,每组30例。其中,超声引导CPB联合SCNB为CS组,超声引导肌间沟臂丛神经阻滞(Interscalene brachial plexus block,ISBPB)联合颈中间丛神经阻滞(Intermediate cervical plexus block,ICPB)为BC组。记录和比较两组患者阻滞成功率、同侧膈肌麻痹发生率、阻滞相关并发症、操作时间、起效时间、上肢运动阻滞评分及血流动力学参数。结果两组阻滞成功率差异无统计学意义(P=1.000);CS组同侧膈肌麻痹发生率显著下降(P<0.001);两组Horner综合征和喉返神经阻滞等不良反应发生率比较,差异无统计学意义(P>0.05);BC组上肢运动功能在阻滞后30 min和手术结束时显著下降,CS组未见明显变化(P<0.001);CS组阻滞操作所需时间较长(P<0.05),但阻滞起效时间两组比较,差异无统计学意义(P>0.05);两组患者血流动力学参数比较,差异无统计学意义(P>0.05)。结论超声引导下CPB联合SCNB能为锁骨中段骨折手术提供充分的麻醉镇痛,且无同侧膈肌麻痹和上肢运动阻滞的风险。Objective To evaluate the application advantages of ultrasound-guided clavipectoral fascial plane block(CPB)combined with supraclavicular nerve block(SCNB)in midclavicular fracture surgery.Methods A total of 60 patients undergoing internal fixation for midclavicular fracture were divided into two groups with 30 cases in each group by random number table method.Among them,ultrasound guided CPB combined with SCNB was CS group,and ultrasound guided interscalene brachial plexus block(ISBPB)combined with intermediate cervical plexus block(ICPB)was the BC group.The success rate of block,incidence of ipsilateral diaphragmatic paralysis,block-related complications,operation time,onset time,upper limb motor block score and hemodynamic parameters were recorded and compared between the two groups.Results There was no significant difference in the success rate of block between the two groups(P=1.000).The incidence of ipsilateral diaphragmatic paralysis in CS group was significantly decreased(P<0.001).There was no significant difference in the incidence of adverse reactions such as Horner syndrome and recurrent laryngeal nerve block between the two groups(P>0.05).The upper limb motor function in BC group decreased significantly at 30 minutes after the block and at the end of the operation,while no significant changes were observed in the CS group(P<0.001).The time of blocking operation in CS group was longer(P<0.05),but there was no significant difference in the onset time of block between the two groups(P>0.05).There were no significant differences in hemodynamic parameters between the two groups(P>0.05).Conclusion Ultrasound-guided CPB combined with SCNB provides adequate anesthesia for midclavicular fracture surgery without the risk of ipsilateral diaphragmatic paralysis and upper limb motor block.

关 键 词：锁胸筋膜平面阻滞 锁骨上神经阻滞 锁骨中段骨折 膈肌麻痹 上肢运动阻滞 

分 类 号：R614[医药卫生—麻醉学]