目的 比较超声引导下肌间沟与腋路入路行臂丛神经阻滞在桡骨远端骨折手术中应用效果。方法 选择2018年1月—2018年12月行桡骨远端骨折手术的患者106例,应用随机数表法分为两组,各53例。入选者均实施臂丛神经阻滞,观察组在超声引导下选取腋路入路,对照组选取肌间沟入路。观察两组支配术区神经痛觉消失时间、麻醉效果及并发症。结果 观察组前臂内侧皮神经、正中神经、尺神经痛觉消失时间分别为(10.18±4.32) min、(13.50±7.06) min、(8.13±4.27) min,较对照组相应时间[(18.04±6.79) min、(19.72±8.14) min、(21.16±6.39) min]缩短,麻醉优秀效果占比(90.57%)较对照组(69.81%)高,麻醉失败占比(3.77%)较对照组(15.09%)低,差异有统计学意义(P＜0.05)。两组前臂外侧皮神经、桡神经痛觉消失时间、并发症发生率对比,差异无统计学意义(P＞0.05)。结论 桡骨远端骨折手术患者接受超声引导下腋路臂丛神经阻滞并发症少且麻醉效果确切,有利于提升神经阻滞效果。
Objective To compare the effects of ultrasound-guided interscalene approach and axillary artery approach of brachial plexus block in distal radius fracture surgery.Methods A total of 106 patients undergoing distal radius fracture surgery in our hospital from January to December 2018 were selected and divided into two groups by random number table, with 53 cases in each group.All selected cases received brachial plexus block, the observation group was given ultrasound-guided axillary artery approach, and the control group was given interscalene approach.The disappearance time of neuralgia, anesthetic effect, and complications in the two groups were observed.Results The neuralgia disappearance time of medial cutaneous nerve of forearm, median nerve, and ulnar nerve in the observation group [(10.18±4.32) min, (13.50±7.06) min, and (8.13±4.27) min] were shorter than the time of the control group [(18.04±6.79) min, (19.72±8.14) min, and (21.16±6.39) min]; the rate of successful anesthesia in the observation group (90.57%) was higher than that in the control group (69.81%); and the rate of anesthesia failure in the observation group (3.77%) was lower than that in the control group (15.09%) (P<0.05).There were no statistical differences in the neuralgia disappearance time of lateral cutaneous nerve of forearm and musculospiral nerve and the incidence rate of complications between the two groups (P>0.05).Conclusion Ultrasound-guided axillary artery approach of brachial plexus block for patients with distal radius fracture surgery produces less complications and good anesthetic effect, which can increase the effect of nerve block.
[1] 王翠宝,魏南服,余亚丁,等.两种锁骨上臂丛神经阻滞方案在老年肱骨骨折患者中的麻醉效果比较[J].中国老年学杂志, 2018,38(12):2925-2927.
[2] 陶蕾,杨世忠.B超引导下臂丛神经阻滞在儿童尺桡骨骨折手术中的应用[J].医学研究杂志, 2018,47(4):73-77.
[3] 万凌峰,卢明,宫尚珍,等.超声引导下肌间沟臂丛神经阻滞复合全身麻醉在肩胛骨骨折手术中的应用[J].浙江临床医学, 2017,19(1):146-147,150.
[4] 张清文.不同浓度罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的麻醉效果[J].医疗装备, 2017,30(13):125-126.
[5] 马彦文.不同剂量瑞芬太尼联合臂丛神经阻滞对上肢骨折术麻醉疗效分析[J].中国伤残医学, 2017,25(16):54-55.
[6] 张华,焦天明.超声引导定位下腋路臂丛神经阻滞不同剂量利多卡因复合罗哌卡因剂量的使用研究[J].中国实用神经疾病杂志, 2018,21(18):1998-2005.
[7] 刘遵勇,倪康裕.手法整复及手术整复治疗老年桡骨远端骨折伴正中神经损伤患者的临床疗效及对腕关节功能的影响[J].中国老年学杂志, 2018,38(10):2396-2398.
[8] 贺峰,白建云,霍建臻,等.椎旁神经阻滞与肌间沟臂丛神经阻滞联合颈浅丛神经阻滞用于锁骨骨折手术麻醉的效果比较[J].中国医药导报, 2017,14(25):81-84.
[9] Barrington M J, Gledhill S R, Kluger R, et al.A randomized controlled trial of ultrasound versus nerve stimulator guidance for axillary brachial plexus block[J].Region Anesth Pain M, 2016,41(6):671-677.
[10] 王伟华,王沫丽,孙俊.超声引导下与神经刺激器联合超声引导下腋路臂丛神经阻滞在下肘部位手术患者麻醉中应用比较[J].医学临床研究, 2017,34(1):61-63.
