不同神经阻滞方式在锁骨骨折手术中的应用效果

摘要

Objective To compare the effects between combined block of cervical 5-superficial cervical plexus versus combined block of intermuscular brachial plexus-superficial cervical plexus applied to the clavicle surgery .Methods Sixty patients with clavicle fracture scheduled for surgery were randomly divided into combined block of cervical 5-superficial cervical plexus group ( group A ) and combined block of intermuscular brachial plexus-superficial cervical plexus group (group B),with 30 patients in each group.The anesthesia effects were compared between the two groups .Heart rate and blood pressure were recorded before successful block (T0),10(T1) and 30 minutes(T2) after successful block,the lung forced vital capacity (FVC) was determined at 30 minutes,1 and 4 hours after successful block in the two groups,the ratio of FVC at 30 minutes,1 or 4 hours after successful block to FVC before block was calculated ,and the incidence of complications and the patients′satisfaction to anesthesia were compared between the two groups .Results There was no significant difference in the anesthesia effects or complications between the two groups (P>0.05).Heart rate,blood pressure and FVC decreased in the two groups over time(P<0.05).Heart rates and blood pressures at T1 and T2,and FVC%at each time point in group A were higher than those in group B(P<0.05).The satisfaction of patients in group A was higher than that in group B (P<0.05).Conclusion Ultrasound -guided cervical 5-superficial cervical plexus block applied to surgery for clavicle fracture has quicker onset time of block , longer maintenance time,and higher satisfaction of the patients .%目的 比较颈5-颈浅丛神经联合阻滞与肌间沟臂丛-颈浅丛神经联合阻滞在锁骨手术中应用效果.方法 将60例拟行锁骨骨折手术患者随机分为颈5-颈浅丛神经联合阻滞组(A组)与肌间沟臂丛-颈浅丛神经联合阻滞组(B组),每组30例.比较两组的麻醉效果,并记录两组成功阻滞前(T0)、成功阻滞后10 min(T1)、30 min(T2)的心率及血压,测定阻滞成功后的30 min、1 h及4 h的肺用力肺活量(FVC),并计算阻滞成功后的30 min、1 h及4 h的FVC与阻滞前FVC之比,比较两组并发症发生情况及患者麻醉满意情况.结果 两组麻醉效果及并发症比较,差异无统计学意义(P>0.05).两组心率、血压及FVC均随时间延长而降低(P<0.05),但T 1及T2的心率及血压、各时点FVC%均高于B组(P<0.05).A组患者满意度高于B组(P<0.05).结论 超声引导下颈5-颈浅丛神经阻滞应用于锁骨骨折手术,阻滞起效更快,维持时间更长,患者满意度高.