颈浅丛阻滞联合颈5神经根阻滞或胸锁筋膜平面阻滞在锁骨骨折内固定术中的应用效果  

The application effects of superficial cervical plexus block combined with cervical 5 nerve root block or sternoclavicular fascia plane block in internal fixation of clavicular fractures

作　　者：李沛函 王雪娟 李成文 李丽[1] LI Peihan;WANG Xuejuan;LI Chengwen;LI Li(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《中国临床新医学》2024年第12期1357-1362,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：国家自然科学基金面上项目(编号:82271307)。

摘　　要：目的比较颈浅丛阻滞联合颈5神经根阻滞和颈浅丛阻滞联合胸锁筋膜平面阻滞在锁骨骨折内固定术中的应用效果。方法招募2021年3月至2023年12月于首都医科大学附属北京友谊医院择期行锁骨骨折内固定术的单侧锁骨中段骨折患者60例,采用随机数字表法将其分为观察组(接受颈浅丛阻滞联合颈5神经根阻滞)和对照组(接受颈浅丛阻滞联合胸锁筋膜平面阻滞),每组30例。比较两组手术时间、术中出血量、舒芬太尼和丙泊酚用量、神经阻滞效果、术中心率(HR)及平均动脉压(MAP)水平、术后视觉模拟量表(VAS)评分、阻滞后上肢运动功能改良Bromage量表(MBS)评分以及并发症发生情况。结果观察组术中舒芬太尼和丙泊酚用量少于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中出血量及术后首次口服镇痛药物时间比较差异无统计学意义(P>0.05)。两组术中不同时间点HR、MAP水平保持稳定,组间比较差异无统计学意义(P>0.05)。所有患者神经阻滞效果均为良好。两组术后30 min、4 h、12 h、24 h VAS评分均呈先下降后上升的趋势,观察组各观察时间点VAS评分均显著低于对照组(P<0.05)。在阻滞后30 min及术后4 h、12 h、24 h,两组屈肘、屈腕、屈指的MBS评分均呈上升趋势,组间比较差异无统计学意义(P>0.05)。观察组术后发生轻度Horner综合征1例,膈肌部分麻痹1例,对照组无并发症发生。结论与颈浅丛阻滞联合胸锁筋膜平面阻滞相比,颈浅丛阻滞联合颈5神经根阻滞术中舒芬太尼和丙泊酚用量更少,但两种麻醉方法均可较好保留患侧上肢的运动功能,且膈神经阻滞、喉返神经阻滞等并发症发生率低。Objective To compare the application effects of superficial cervical plexus block combined with cervical 5 nerve root block and superficial cervical plexus block combined with sternoclavicular fascia plane block in internal fixation of clavicular fractures.Methods A total of 60 patients with unilateral midclavicular fractures who underwent elective internal fixation of clavicular fractures in Beijing Friendship Hospital,Capital Medical University from March 2021 to December 2023 were recruited.The patients were divided into observation group(receiving superficial cervical plexus block combined with cervical 5 nerve root block)and control group(receiving superficial cervical plexus block combined with sternoclavicular fascia plane block)by using random number table method,with 30 cases in each group.The operation time,intraoperative blood loss,sufentanil and propofol dosages,as well as the effectiveness of nerve block,intraoperative heart rate(HR),mean arterial pressure(MAP)level,postoperative Visual Analogue Scale(VAS)scores,modified Bromage Scale(MBS)scores for upper limb motor function after nerve block,and incidence of complications were compared between the two groups.Results The intraoperative dosages of sufentanil and propofol in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There were no statistically significant differences between the two groups in terms of the operation time,intraoperative blood loss,and the time of first oral analgesic medication after operation(P>0.05).The levels of HR and MAP at different time points during operation in the two groups kept stable,and there were no statistically significant differences between the groups(P>0.05).The effectivenesses of nerve block were good in all the patients.The VAS scores in both groups showed a trend of first decreasing and then increasing at 30 minutes,4 hours,12 hours and 24 hours after operation.At all the time points,the VAS scores in the observation group were signific

关 键 词：超声引导 颈浅丛阻滞 颈5神经根阻滞 胸锁筋膜平面阻滞 锁骨骨折内固定术 

分 类 号：R614.4[医药卫生—麻醉学]