摘要
目的探讨超声引导下锁骨上神经阻滞联合锁骨周围浸润麻醉在锁骨内固定手术中的应用效果。方法100例锁骨骨折拟行切开复位内固定手术的患者,采用随机数字表法分为观察组和对照组,每组50例。观察组采用超声引导下锁骨上神经阻滞联合锁骨周围浸润麻醉,对照组采用超声引导下颈浅丛联合肌间沟臂丛阻滞。比较两组麻醉操作时间、麻醉起效时间及麻醉效果,不同时间点[入室时(T0)、麻醉时(T1)、切皮时(T2)、复位时(T3)和手术结束时(T4)]血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))],手术结束时患侧上肢改良Bromage评分及不同时间点(术后6、12、24 h)视觉模拟评分法(VAS)评分,麻醉满意度;分析两组并发症发生情况。结果观察组麻醉操作时间(5.0±0.5)min及麻醉起效时间(3.1±1.1)min均短于对照组的(6.4±0.5)、(11.2±1.8)min,差异有统计学意义(P<0.05);两组麻醉总有效率比较,差异无统计学意义(P>0.05)。T0、T1、T2、T3、T4时,两组患者MAP、HR、SpO_(2)比较,差异无统计学意义(P>0.05)。观察组手术结束时患侧上肢改良Bromage评分(3.7±1.5)分高于对照组的(0.8±0.1)分,差异有统计学意义(P<0.05);术后6、12、24 h,两组VAS评分比较,差异无统计学意义(P>0.05)。观察组麻醉满意度90%高于对照组的74%,差异有统计学意义(P<0.05)。两组患者均未出现明显麻醉相关并发症。结论超声引导下锁骨上神经阻滞联合锁骨周围浸润麻醉在锁骨内固定手术中麻醉效果满意,其操作时间短、起效快,不影响术侧上肢活动,患者满意度高,在锁骨手术中具有推广价值。
Objective To discuss the application effect of ultrasound-guided supraclavicular nerve block combined with periclavicular infiltration anesthesia in internal fixation of clavicle fracture.Methods A total of 100 patients with clavicular fracture who underwent open reduction and internal fixation were divided into the observation group and the control group according to the random numerical table,with 50 cases in each group.The observation group was treated with ultrasound-guided supraclavicular nerve block and periclavicular infiltration anesthesia,while the control group was treated with ultrasound-guided superficial cervical plexus and interscalene brachial plexus block.Both groups were compared in terms of anesthesia operation time,anesthesia onset time and anesthesia effect,hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))]at different time points[at entering the operating room(T0),anesthesia(T1),skin incision(T2),fracture reduction(T3)and end of surgery(T4)],modified Bromage score of the affected upper limb at the end of the surgery,visual analogue scale(VAS)score at different time points(6,12,24 h after the surgery),and the satisfaction of anesthesia;the occurrence of complications in the two groups was analyzed.Results The anesthesia operation time of(5.0±0.5)min and the anesthesia onset time of(3.1±1.1)min in the observation group were shorter than those of(6.4±0.5)and(11.2±1.8)min in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in total effective rate of anesthesia between the two groups(P>0.05).At T0,T1,T2,T3 and T4,there was no statistically significant difference in terms of MAP,HR and SpO_(2) between the two groups(P>0.05).The modified Bromage score of the affected upper limb was(3.7±1.5)points in the observation group at the end of the surgery,which was higher than that of(0.8±0.1)points in the control group,and the difference was statistically significant(P<0.05).At 6
作者
赵园园
夏书江
李元海
夏晓琼
ZHAO Yuan-yuan;XIA Shu-jiang;LI Yuan-hai(Department of Anesthesiology,Chaohu Hospital Affliated to Anhui Medical University,Chaohu 238000,China)
出处
《中国实用医药》
2023年第22期27-31,共5页
China Practical Medicine
基金
安徽省卫生健康适宜技术推广项目(项目编号:SYJS201912)。
关键词
锁骨骨折
切开复位内固定手术
超声引导
锁骨上神经阻滞
锁骨周围浸润麻醉
Clavicle fracture
Open reduction and internal fixation
Ultrasound guidance
Supraclavicular nerve block
Periclavicular infiltration anesthesia
