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超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中应用效果的随机对照研究
Efficiency of ultrasound guided C5 combined with cervical plexus block versus high brachial plexus block in clavicle operation: a randomized controlled trial
- 第三军医大学学报 2018年40卷第3期 页码：242-247
- 作者机构：
1.710077 西安，西安医学院第一附属医院：麻醉科
2.710077 西安，西安医学院第一附属医院：骨科
3.710077 西安，西安医学院第一附属医院：神经外科
- 作者简介：
[ 盛旭东，E-mail：aaasxd@sina.com SHENG Xudong, E-mail: aaasxd@sina.com
- 基金信息：陕西省教育厅面上项目(16JK1648)
DOI：10.16016/j.1000-5404.201707090
中图分类号： R445.1;R614.4;R681.7收稿：2017-07-13，
修回：2017-11-17，
纸质出版：2018-02-15
- 稿件说明：
移动端阅览
赵玲, 李静, 党旭云, 等. 超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中应用效果的随机对照研究[J]. 第三军医大学学报, 2018,40(3):242-247.
Ling ZHAO, Jing LI, Xuyun DANG, et al. Efficiency of ultrasound guided C5 combined with cervical plexus block versus high brachial plexus block in clavicle operation: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(3): 242-247.
赵玲, 李静, 党旭云, 等. 超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中应用效果的随机对照研究[J]. 第三军医大学学报, 2018,40(3):242-247. DOI： 10.16016/j.1000-5404.201707090.
Ling ZHAO, Jing LI, Xuyun DANG, et al. Efficiency of ultrasound guided C5 combined with cervical plexus block versus high brachial plexus block in clavicle operation: a randomized controlled trial[J]. Journal of Third Military Medical University, 2018, 40(3): 242-247. DOI： 10.16016/j.1000-5404.201707090.
摘要
目的
2
比较超声引导下C5和颈浅丛联合阻滞与高位臂丛神经阻滞在锁骨手术中的应用效果。
方法
2
选择我院2016年2-11月骨科ASA分级Ⅰ~Ⅱ级拟在神经阻滞麻醉下接受锁骨手术的患者58例，按照随机数字表法分为两组进行随机对照研究：C5和颈浅丛联合阻滞组(A组，
n
=29)与高位臂丛神经阻滞组(B组，
n
=29)。超声引导下穿刺，针尖到达目标位置后，回抽无液体，注入局麻药。记录患者穿刺前(T
0
)、穿刺成功后10 min(T
1
)、30 min(T
2
)心率，平均动脉压；术中剥离骨膜时，手术后1、6 h对患者进行VAS评分，记录霍纳综合征并对各组在阻滞成功后进行麻醉效果评价。
结果
2
超声引导下C5和颈浅丛联合阻滞比高位肌间沟阻滞麻醉起效时间更短(
P
<
0.05)，阻滞维持时间更长(
P
<
0.05)，运动神经阻滞概率较低(
P
<
0.05)。霍纳征发生率较高位臂丛神经阻滞组低(
P
<
0.05)。剥离骨膜时及术后1、6 h高位臂丛神经阻患者VAS评分明显高于C5和颈浅丛联合阻滞组(
P
<
0.05)。术中芬太尼用量及术后30 min对患者肺功能影响均较小(
P
<
0.05)，患者感觉比较满意(
P
<
0.05)。
结论
2
锁骨骨折手术应用超声引导下C5和颈浅丛联合阻滞麻醉优于高位臂丛神经阻滞麻醉。
Abstract
Objective
2
To observe the efficacy of ultrasound-guided C5 combined with cervical plexus block and high brachial plexus block in clavicle operation.
Methods
2
Fifty-eight cases undergoing selective upper limb surgery under brachial plexus block admitted in our orthopedic department from February to November 2016 were recruited in this study. They were at an American Society of Anesthesiologists (ASA) of Ⅰ to Ⅱ
an
d were randomly divided into C5 combined with cervical plexus block group (group A
n
=29) and high brachial plexus block group (group B
n
=29). When ultrasound guided the needle reaching the target position and no liquid was withdrawn
the local anesthetic was injected. The heart rate and mean arterial pressure were recorded before successful puncture (T
0
)
and in 10 (T
1
) and 30 min (T
2
) after successfully puncture. Visual analogue scale (VAS) score was scored in 1 and 6 h after operation and the moment of stripping periosteum. Horner's syndrome was recorded
and the efficacy of anesthesia in the 2 groups was evaluated.
Results
2
The group A had shorter onset time of anesthesia (
P
<
0.05)
longer block duration (
P
<
0.05)
lower motor nerve block rate onset time (
P
<
0.05)
and lower incidence rate of Horner's syndrome when compared with group B. The VAS score was significantly lower in group B than the group A at the moment of stripping periosteum and in 1 and 6 h postoperatively (
P
<
0.05). The fentanyl amount used during the operation and effect on the lung function in 30 min after operation were quite lower in the group A than group B (
P
<
0.05). The patients in group A were more satisfied (
P
<
0.05).
Conclusion
2
C5 combined with cervical plexus block under ultrasound guidance is a better option for anesthesia in clavicular fracture.
关键词
Keywords
references
徐天, 王薇薇.锁骨骨折内固定术中两种麻醉方法的麻醉效果比较[J].医学综述, 2015, 21(11): 2101-2103. DOI:10.3969/j.issn.1006-2084.2015.11.071.
XU T, WANG W W. Comparison of anesthetic effect of two anesthesia methods in clavicular fracture fixation[J]. Med Recapitulate, 2015, 21(11):2101-2103. DOI:10.3969/j.issn.1006-2084.2015.11.071.
刘枧辉, 曹保锋, 陈文娟, 等.应用神经刺激器辅助定位观察单点法高位肌间沟神经阻滞对锁骨手术麻醉效果的影响[J].河北医药, 2017, 39(15): 2285-2288. DOI:10.3969/j.issn.1002-7386.2017.15.011.
LIU J H, CAO B F, CHEN W J, et al . Effect of nerve stimulation assisted positioning on the anesthesia effect of high position intermuscular nerve block with single point method on clavicle surgery[J ] . Hebei Med J, 2017, 39(15):2285-2288.DOI:10.3969/j.issn.1002-7386.2017.15.011.
胡焱, 袁嫕, 张文超, 等.颈丛臂丛联合神经阻滞用于锁骨切开复位内固定术的临床观察[J].山东医药, 2017, 57(16): 62-64. DOI:10.3969/j.issn.1002-266X.2017.16.020.
HU Y, YUAN Y, ZHANG W C, et al . Clinical observation of cervical plexus block combined with brachial plexus block for the reduction and internal fixation of clavicle[J ] . Shandong Med J, 2017, 57(16):62-64. DOI:10.3969/j.issn.1002-266X.2017.16.020.
柯纬祺. B超定位肌间沟臂丛神经阻滞与神经刺激仪引导肌间沟臂丛神经阻滞的对比[J].吉林医学, 2014, 35(34): 7622-7623. DOI:10.3969/j.issn.1004-0412.2014.34.037.
KE W Q. Comparison between ultrasound-guided brachial plexus block and brachial plexus block guided by nerve stimulator[J]. Jilin Med J, 2014, 35(34):7622-7623. DOI:10.3969/j.issn.1004-0412.2014.34.037.
赵玲, 张海雄, 盛旭东, 等.椎旁联合腰丛-坐骨神经阻滞在肥胖高龄患者髋关节置换术中的应用[J].第三军医大学学报, 2013, 35(17): 1875-1877.
ZHAO L, ZHANG H X, SHENG X D, et al . Application of paravertebral nerve block combined lumbosacral plexus block in obese elderly patients undergoing hip replacement[J ] . J Third Mil Med Univ, 2013, 35(17):1875-1877.
SARANTEAS T, KOSTOPANAGIOTOU G G, ANAGNOSTOPOULOU S, et al . A simple method for blocking the deep cervical nerve plexus using an ultrasound-guided technique[J ] . Anaesth Intensive Care, 2011, 39(5): 971-972.
DIEUDONNE N, GOMOLA A, BONNICHON P, et al . Prevention of postoperative pain after thyroid surgery: a double-blind randomized study of bilateral superficial cervical plexus blocks[J ] . Anesth Analg, 2001, 92(6): 1538-1542. DOI:10.1097/00000539-200106000-00038.
杨永刚, 葛东明.超声引导下胸锁乳突肌间隙颈浅丛神经阻滞麻醉用于锁骨手术的临床效果[J].上海医学, 2014, 37(10): 831-834.
YANG Y G, GE D M.Analgesic efficacy of ultrasound-guided spatium intermusculare block of superficial cervical plexus during clavicle fixation[J]. Shanghai Med J, 2014, 37(10):831-834.
孙朗荣, 杨玉华, 吴友刚, 等.高位肌间沟臂丛麻醉在骨科患者中的应用[J].吉林医学, 2014, 35(36): 8100-8101. DOI:10.3969/j.issn.1004-0412.2014.36.071.
SUN L R, YANG Y H, WU Y G, et al . Application of high interscalene brachial plexus anesthesia in clavicle surgery[J ] . Jilin Med J, 2014, 35(36): 8100-8101. DOI:10.3969/j.issn.1004-0412.2014.36.071.
吴川, 仝烨峰, 刘朋, 等.超声联合神经刺激器肌间沟臂丛麻醉用于肩关节周围手术的效果[J].实用医学杂志, 2016, 32(15): 2498-2500.DOI:10.3969/j.issn.1006-5725.2016.15.024.
WU C, TONG Y F, LIU P, et al .Effect of ultrasound-guided interscalene brachial plexus block and nerve stimulator on operation around shoulder joints[J ] . J Pract Med, 2016, 32(15): 2498-2500.DOI:10.3969/j.issn.1006-5725.2016.15.024.
PINTARIC T S, HOCEVAR M, JEREB S, et al . A prospective, randomized comparison between combined (deep and superficial) and superficial cervical plexus block with levobupivacaine for minimally invasive parathyroidectomy[J ] . Anesth Analg, 2007, 105(4): 1160-1163. DOI:10.1213/01.ane.0000280443.03867.12.
马龙, 徐鹏, 耿智隆, 等.罗哌卡因和布比卡因超声引导肌间沟神经阻滞对患者膈肌移动度和呼吸功能的影响[J].华南国防医学杂志, 2016, 30(9): 606-608.
MA L, XU P, GENG Z L, et al .Effects of ropivacaine and bupivacaine on the mobility of phrenic muscle and respiratory function in patients undergoing ultrasound-guided interscalene brachial plexus anesthesia[J ] . Mil Med J South China, 2016, 30(9):606-608.
SAIT KAVAKLI A, KAVRUTÖZTÜRK N, UMUT AYOǦLU R, et al . Comparison of combined (deep and superficial) and intermediate cervical plexus block by use of ultrasound guidance for carotid endarterectomy[J ] . J Cardiothorac Vasc Anesth, 2016, 30(2): 317-322. DOI:10.1053/j.jvca.2015.07.032.
SHANTHANNA H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle[J]. Indian J Anaesth, 2014, 58(3): 327. DOI:10.4103/0019-5049.135050.
KLINE J P. Ultrasound-guided placement of combined superficial cervical plexus and selective C5 nerve root catheters: a novel approach to treating distal clavicle surgical pain[J]. AANA J, 2013, 81(1): 19-22.
邓兆宏, 孙万群.星状神经节阻滞入路的应用解剖[J].郧阳医学院学报, 2007, 26(1):44-45. DOI:10.3969/j.issn.1006-9674.2007.01.017.
DENG Z H, SUN W Q. Applied anatomy of stellate ganglion block[J]. J Hubei Univ Med, 2007, 26(1):44-45. DOI:10.3969/j.issn.1006-9674.2007.01.017.
刘彦国, 石献忠, 梁海鹏, 等.星状神经节的应用解剖及其与Horner综合征关系的探讨[J].中国临床解剖学杂志, 2006, 24(1): 67-69. DOI:10.3969/j.issn.1001-165X.2006.01.018.
LIU Y G, SHI X Z, LIANG H P, et al . The applied anatomy of stellate ganglion and it's relationship with Horner's syndrome[J ] . Chin J Clin Anatomy, 2006, 24(1):67-69.DOI:10.3969/j.issn.1001-165X.2006.01.018.
刘喆, 高项羽, 付红光.左侧星状神经节阻滞对冠脉搭桥术患者心率变异性的影响[J].广东医学, 2016, 37(11): 1682-1685. DOI:10.13820/j.cnki.gdyx.2016.11.023.
LIU Z, GAO X Y, FU H G. Effect of left stellate ganglion block on heart rate variability in patients undergoing coronary artery cross-bridge surgery[J]. Guangdong Med J, 2016, 37(11):1682-1685. DOI:10.13820/j.cnki.gdyx.2016.11.023.
LOYALKA P, HARIHARAN R, GHOLKAR G, et al . Left stellate ganglion block for continuous ventricular arrhythmias during percutaneous left ventricular assist device support[J ] . Tex Heart Inst J, 2011, 38(4): 409-411.
HORTENSE A, PEREZ M V, AMARAL J L, et al . Interscalene brachial plexus block. Effects on pulmonary function[J ] . Rev Bras Anestesiol, 2010, 60(2): 130-137. DOI:10.1016/s0034-7094(10)70017-9.
黄娟娟, 胡焕盛, 安小凤, 等.同一剂量不同容量罗哌卡因超声引导肌间沟臂丛神经阻滞对膈肌移动度的影响[J].临床麻醉学杂志, 2015, 31(12): 1176-1179.
HUANG J J, HU H S, AN X F, et al . Influence of different volumes of ropivacaine with isodosage on diaphragmatic excursion following ultrarsound-guided interscalene brachial plexus block[J ] . J Clin Anesthesiol, 2015, 31(12):1177-1179.
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