超声和神经刺激仪引导下肌间沟臂丛阻滞用于锁骨骨折的效果

超声和神经刺激仪引导下肌间沟臂丛阻滞用于锁骨骨折的

效果

蔡宜良，陈家趁，曹玉云，关小园

作者单位：阳江市阳东区人民医院麻醉科，广东

阳江529931

基金项目：阳江市卫生和计划生育局项目（阳卫计2016041）

摘要：目的

探讨超声+神经刺激仪（PNS ）引导下肌间沟臂丛阻滞在锁骨骨折手术治疗中的应用效果及对病人血清应激指

标的影响。方法

选取阳江市阳东区人民医院拟实施手术治疗的锁骨骨折病人100例（2017年6月至2018年11月）采用随机

数字表法分为引导组和常规组各50例，引导组采用超声+PNS 引导下肌间沟臂丛+颈浅丛神经阻滞麻醉、常规组采用传统一针法实施肌间沟臂丛+颈浅丛神经阻滞麻醉；对比两组的平均动脉压（MAP ）、心率（HR ）、动脉血氧饱和度（SpO 2）变化，记录两组病人的感觉起效时间、镇痛维持时间、运动阻滞起效时间、运动阻滞维持时间，术前及术后12h 的血清去甲肾上腺素（NE ）、皮质醇（Cor ）、肾上腺素（E ）水平变化及不良反应。结果

引导组和常规组病人在T0～T3时刻的HR 、MAP 及SpO 2测定值变化趋

势组间比较差异均不具有统计学意义（P >0.05）；引导组和常规组病人在T1～T3时刻的HR 、MAP 及SpO 2测定值较本组T0时刻均呈现不同程度的降低（P <0.05）；引导组病人的感觉起效时间（6.88±2.04）min 、运动阻滞起效时间（13.8±3.5）min 、运动阻滞维持时间（115.8±22.9）min 均低于常规组病人（8.90±2.71）min 、（17.3±4.8）min 、（142.4±29.5）min （P <0.05），引导组病人的镇痛维持时间（426.8±58.1）min 显著的长于常规组（369.0±50.2）min （P <0.05）；术前，两组病人的血清NE 、Cor 、E 水平差异无统计学意义（P >0.05）；术后12h ，引导组病人的血清NE （101.8±20.6）ng/L 、Cor （62.4±10.5）µg/L 、E （472.0±148.2）nmol/L 均低于常规组病人NE （130.2±28.1）ng/L 、Cor （85.1±14.3）µg/L 、E （605.8±180.5）nmol/L （P <0.05）；引导组病人的麻醉相关并发症发生率4.00%低于常规组病人的18.00（P <0.05）。结论

PNS 引导下肌间沟臂丛联合颈浅丛神经阻滞在锁骨骨折手术中应用有利于提高神经阻

滞中的精准性，缩短麻醉阻滞起效时间、延长麻醉时间的同时减轻机体对手术产生的应激反应。关键词：臂神经丛阻滞；超声检查；神经刺激仪；臂丛；锁骨骨折；应激

Effect of ultrasound plus PNS-guided intermuscular sulcus brachial plexus block on clavicle

fracture

CAI Yiliang ，CHEN Jiacheng ，CAO Yuyun ，GUAN Xiaoyuan

Author Affiliation ：Department of Anesthesiology ，People's Hospital of Yangdong District ，Yangjiang ，Guangdong

529931，China

Abstract ：Objective

To explore the effect of ultrasound plus PNS-guided intermuscular sulcus brachial plexus block on clavicle

fracture and its influence on serum stress index.Methods

A total of 100patients with clavicle fractures (from June 2017to November

2018)who were to be operated on from the People's Hospital of Yangdong District,Yangjiang City were assigned into a guided group and a conventional group with 50cases each by a random number table.The guided group received ultrasound +PNS-guided intermus‐cular sulcus brachial plexus +superficial cervical plexus nerve block,and the conventional group used traditional one-needle method

to perform intermuscular sulcus brachial plexus +superficial cervical plexus block anesthesia.Mean artery pressure (MAP),heart rate (HR)and arterial oxygen saturation (SpO 2)were compared between the two groups,and the sensory onset time,analgesic maintenance time,motor block onset time,motor block maintenance time,changes in serum noradrenaline (NE),cortisol (Cor),epinephrine (E)levels and adverse effects were recorded before and 12h after surgery.Results

There was no statistically significant difference in the trend of

changes in HR,MAP and SpO 2measured values between the guided group and the conventional group at T0～T3(P >0.05).The mea‐sured values of HR,MAP and SpO 2of patients in the guided group and the conventional group at T1～T3were lower than those of the groups at T0(P <0.05).The sensory onset time (6.88±2.04)min,motor block onset time (13.8±3.5)min,and motor block maintenance

time (115.8±22.9)min in the guided group were lower than those in the routine group [(8.90±2.71)min,(17.3±4.8)min,(142.4±29.5)min;P <0.05].The analgesic maintenance time in the guided group (426.8±58.1)min was significantly longer than that in the conven‐tional group (369.0±50.2)min (P <0.05).Before surgery,the differences in serum NE,Cor,and E levels of the two groups of patients

were not statistically significant (P >0.05);Twelve hours after surgery,levels of the serum NE (101.8±20.6)ng/L,Cor (62.4±10.5)µg/L,E (472.0±148.2)nmol/L of the patients in the guided group were lower than those of the serum NE (130.2±28.1)ng/L,Cor (85.1±14.3)

◇临床医学

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引用本文：蔡宜良，陈家趁，曹玉云，等.超声和神经刺激仪引导下肌间沟臂丛阻滞用于锁骨骨折的效果［J ］.安徽医药，2021，25（4）：740-743.DOI ：10.3969/j.issn.1009-6469.2021.04.026.