目的：探讨超声引导下锁骨上臂丛神经阻滞为基础的麻醉管理方案在重症老年患者上肢骨折手术麻醉中的有效性和安全性。方法选择拟行锁骨上臂丛阻滞且年龄为60岁以上患者32例，按年龄段分为60～74岁组（17例）和>74岁组（15例）。经便携式超声定位仪于锁骨上窝扫描臂丛神经，采用“平面内”技术在超声图像的引导下调整进针角度及深度，分三针注入罗哌卡因＋右美托咪啶局麻药25～30 ml满意包裹神经丛，辅以合适的镇静、镇痛及血管活性药物维护重要脏器功能。结果>74岁组患者术前ASAⅣ级病例较60～74岁组多，术中镇静、镇痛辅助用药使用比例较60～74岁组少，血管活性药物使用比例较60～74岁组大，差异均有统计学意义（均P＜0．05）；所有患者均按照既定计划完成麻醉，未出现因麻醉效果欠佳而中途转为全身麻醉者，术中镇静评分、合作评分及麻醉效果评分均满意，术后12 h内未见明显并发症发生。结论超声引导下锁骨上臂丛神经阻滞为基础的麻醉管理方案，不仅能满足重症老年患者术中手术需要，而且能有效预防术后并发症的发生。%Objective To explore the efficacy and safety of the anesthesia management based on the ultrasound guided supraclavicular brachial plexus block for incritical elderly patients with upper limbs fracture surgery. Methods Thirty-two patients over 60 years for upper limb fracture operation with ultrasound guided supraclavicular brachial plexus block were enrolled in this study. Patients were divided into two groups according to the age(60~74 years in group A,over 74 years in group B). The brachial plexus in the supraclavicular fossa was scanned with portable ultrasound device,adjusting the angle of the needle and depth under the ultrasound guidance. Altogether 25~30 ml of Ropivacaine and Dexmedetomidine were injected around the nerves, for three times. Then supplemented therapy including appropriate sedation,analgesia,and vascular active drug were used to maintain important viscera function. Results The ASAⅣpatients in group B were more than that in group A before operation. During the operation,the proportion of analgesic/assisted drug was less than group A,the proportion of active drug was more than that in group A(all P<0 . 05). The anesthesia plan was carried out for all patients , without any inefficiency of anesthesia. During operation,sedation score,cooperation score,anaesthesia effect were satisfactory. No obvious postoperative complications occurred 12 h postoperatively. Conclusion The anesthesia management plan of supraclavicular brachial plexus block under ultrasound guidance in critically elderly patients with upper limbs fracture surgery,not only meet the needs of the intraoperative surgery,but also prevent patients from postoperative complications effectively.
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