影像科学与光化学 ›› 2022, Vol. 40 ›› Issue (3): 504-509.DOI: 10.7517/issn.1674-0475.211220

• 综述与论文 • 上一篇    下一篇

超声引导下肌间沟臂丛神经阻滞联合颈浅丛神经阻滞在锁骨骨折术中的应用

付秀丽1, 王森1, 孙志鹏1, 雷凤琼2, 范丽1   

  1. 1. 华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)麻醉科手术室, 湖北 武汉 430015;
    2. 华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)护理部, 湖北 武汉 430015
  • 收稿日期:2021-12-20 出版日期:2022-05-15 发布日期:2022-05-27

Application of Ultrasound-guided Intermuscular Sulcus Brachial Plexus Block Combined with Superficial Cervical Plexus Block in Clavicular Fracture Surgery

FU Xiuli1, WANG Sen1, SUN Zhipeng1, LEI Fengqiong2, FAN Li1   

  1. 1. Operating Room of Anesthesiology Department, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan Maternal and Child Health Hospital), Wuhan 430015, Hubei, P. R. China;
    2. Department of Nursing, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan Maternal and Child Health Hospital), Wuhan 430015, Hubei, P. R. China
  • Received:2021-12-20 Online:2022-05-15 Published:2022-05-27

摘要: 本文分析超声引导下肌间沟臂丛神经阻滞联合颈浅丛神经阻滞与传统一针法肌间沟臂丛神经阻滞联合颈浅丛神经阻滞在锁骨骨折手术中的麻醉效果差异。收集拟接受手术治疗的锁骨骨折患儿104例,采用前瞻性随机试验方案,将104例锁骨骨折患儿分为超声组和传统组,每组52例患儿,对比两组神经阻滞效果、麻醉效果、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的动态波动变化情况、肌力参数及两种麻醉方式引起的不良反应情况。感觉、运动阻滞起效时间对比分析,超声组均短于传统组,而镇痛及运动阻滞维持时间均长于传统组(P<0.05);超声引导下的肌间沟臂丛神经阻滞联合颈浅丛神经阻滞具有更好的神经阻滞效果(P<0.05);超声组患儿术后2 h、6 h、12 h屈肘关节的肌力评价高于传统组(P<0.05);术后并发症率比较,超声组低于传统组(P<0.05)。超声引导下肌间沟臂丛神经阻滞联合颈浅丛神经阻滞较传统一针法肌间沟臂丛神经阻滞联合颈浅丛神经阻滞能更准确地进行操作,缩短操作时间,麻醉效果更好,对患儿肌力恢复影响更小,麻醉并发症率更低。

关键词: 超声引导, 锁骨骨折, 肌间沟臂丛神经阻滞, 颈浅丛神经阻滞, 麻醉效果

Abstract: This paper analyzed the difference in anesthesia effect between ultrasound-guided intermuscular sulcus brachial plexus block combined with superficial cervical plexus block and traditional one-needle method of intermuscular sulcus brachial plexus block combined with superficial cervical plexus block in clavicle fracture surgery. 104 children with clavicular fractures who were to undergo surgical treatment were collected, and a prospective randomized trial plan was used to divide the 104 children with clavicular fractures into an ultrasound group and a traditional group, with 52 children in each group. Compared the effects of nerve block, anesthesia effect, mean arterial pressure (MAP), heart rate (HR), dynamic fluctuation of blood oxygen saturation (SpO2), muscle strength parameters and adverse reactions caused by two anesthesia methods in the two groups. Comparative analysis of the onset time of sensory and motor blocks showed that the ultrasound group was shorter than the traditional group, while the duration of analgesia and motor block were longer than those of the traditional group (P<0.05). Ultrasound-guided intermuscular sulcus brachial plexus block combined with superficial cervical plexus block had better nerve block effect (P<0.05). The muscle strength of the elbow flexion joint of the children in the ultrasound group was higher than that in the traditional group at 2 h, 6 h, and 12 h after operation (P<0.05). The postoperative complication rate in the ultrasound group was lower than that in the traditional group (P<0.05). Ultrasound-guided intermuscular sulcus brachial plexus block combined with superficial cervical plexus block can perform more accurate operation than traditional one-needle method of intermuscular sulcus brachial plexus block combined with superficial cervical plexus block, with shorter operation time, and better anesthesia effect. As well as the side-effect on muscle strength recovery of children is smaller, and the rate of anesthesia complications is lower.

Key words: ultrasound guidance, clavicular fracture, intermuscular sulcus brachial plexus block, superficial cervical plexus block, anesthetic effect