双腔喉罩全麻复合臂丛神经阻滞在老年锁骨骨折手术中的应用

摘要

目的：探讨双腔喉罩复合臂丛神经阻滞（肌间沟）对老年患者锁骨骨折手术的影响。方法选择60例年龄60~80岁拟行锁骨骨折内固定术患者，随机分成A、B、C三组，每组20例。A组：使用气管插管全麻；B组：使用臂丛神经阻滞（肌间沟）复合同侧颈浅神经丛阻滞麻醉；C组：使用双腔喉罩插管复合臂丛神经阻滞麻醉。观察并记录患者入室后5 min（T1）、麻醉操作后（T2）、手术开始时（T3）、手术结束时（T4）的心率（HR）、血压（BP）、血氧饱和度（SpO2）的变化，以及三组患者术后并发症的发生情况和视觉模拟评分（ VAS）情况。结果与T1时刻比较，A组患者在T2，T3， T4时刻的HR、BP有显著升高，明显波动（ P 0.05）。三组患者各时间点SpO2无明显差异（ P >0.05）。A组、B组、C组术后不良反应发生率为55.0%、40.0%和20.0%。A组、B组不良反应发生率均明显高于C组，差异具有显著性（ P 0.05）。结论双腔喉罩复合臂丛神经阻滞用于老年锁骨骨折内固定手术，麻醉效果确切，不良反应小，安全可靠。%Objective To explore the effect of combined ProSeal laryngeal mask airway with brachial plexus block( interscalene)on eld-erly patients undergone the operation of the fracture of the clavicle. Methods A total of 60 patients with the age of 60~80 were selected and di-vided into three groups,each group 20 patients. Group A:patients who need the operation of the fracture of the clavicle received the tracheal intu-bation anesthesia;Group B:patients who need the operation of the fracture of the clavicle received the brachial plexus block( interscalene )and ipsilateral superficial cervical block;Group C:patients who need the operation of the fracture of the clavicle received ProSeal laryngeal mask intu-bation anesthesia and brachial plexus block. Three indexes including HR,BP,SpO2 have been examined at five time-points:before entering op-erating room(T1),after anesthesia operation(T2),beginning of the operation(T3),after the operation(T5). The postoperative complications have also been monitored. And all patients could receive the visual analogue scale. Results Compared with T1 time-point,HR and BP have significantly difference at T2,T3,T4 in group A( P 0. 05). The adverse reaction rate after operation in Group A,Group B,Group C was respectively 55. 0%,40. 0% and 20. 0%. Group A, Group B were significantly higher than group C( P <0. 05)The VAS of patients in group C was significantly lower than those patients in group A ( P <0. 05),but there was no significant difference between group B and C. Conclusion ProSeal laryngeal mask airway combined with brachial plexus block( interscalene )is a new anesthesia approach for the surgery of agedness clavicular fracture. The approach is convenient,practical, safe and reliable with a significance of anesthesia effect.