实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (10): 1040-1044.doi: 10.3969/j.issn.1003-9198.2021.10.011

• 临床研究 • 上一篇    下一篇

老年病人超声引导下肋锁径路神经阻滞与腋路臂丛神经阻滞的效果及安全性比较

朱炜, 周瑜, 杨许丽, 张津玮   

  1. 210008 江苏省南京市,南京大学医学院附属鼓楼医院麻醉科
  • 收稿日期:2020-11-25 出版日期:2021-10-20 发布日期:2021-10-13
  • 通讯作者: 张津玮,Email:zjw982@163.com
  • 基金资助:
    十三五南京市卫生青年人才培养工程(QRX17054)

Comparison of the anesthesia effect and safety between ultrasound-guided costoclavicular brachial plexus block and ultrasound-guided axillary brachial plexus block in elderly patients

ZHU Wei, ZHOU Yu, YANG Xu-li, ZHANG Jin-wei   

  1. Department of Anesthesia, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-11-25 Online:2021-10-20 Published:2021-10-13

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摘要： 目的 比较不同浓度罗哌卡因对老年双侧上臂远端骨折病人行超声引导下肋锁径路臂丛神经阻滞(CBPB)与腋路臂丛神经阻滞(ABPB)的效果及安全性。 方法 选择双侧上臂远端骨折的老年病人共80例,将所有病人按性别分层随机平均分为A1组、A2组、B1组和B2组。A1组行0.25%罗哌卡因0.5 mL/kg超声引导下CBPB,A2组行0.1875%罗哌卡因0.5 mL/kg超声引导下CBPB,B1组行0.25%罗哌卡因0.5 mL/kg超声引导下ABPB,B2组行0.1875%罗哌卡因0.5 mL/kg超声引导下ABPB。记录并比较4组的阻滞操作时间、调针次数、起效时间、感觉与运动神经阻滞率、不良反应发生情况及病人术后满意度。 结果 与A1组相比,B1、B2组的操作时间及桡神经、肌皮神经起效时间显著延长,调针次数显著增多(均P<0.01);A2组各支神经起效时间均显著延长(P<0.05或P<0.01)。与A2组相比,B1、B2组的操作时间及桡神经起效时间显著延长,尺神经起效时间显著缩短,调针次数显著增多(均P<0.01)。A1组各支神经的感觉神经阻滞率、运动神经阻滞率均明显高于B2组(P<0.05);A1组与A2组各支神经的感觉神经阻滞率、运动神经阻滞率差异无统计学意义(P>0.05)。4组不良反应发生率差异无统计学意义(P>0.05)。A1、A2组的病人满意度均显著高于B1、B2组(P<0.01)。 结论 与ABPB相比,老年双侧上臂远端骨折病人行超声引导下CBPB的操作时间短、调针次数少、神经阻滞效果好、病人满意度高,且使用0.1875%的罗哌卡因(0.5 mL/kg)就可获得满意的临床效果。

关键词: 肋锁间隙臂丛神经阻滞, 腋路臂丛神经阻滞, 罗哌卡因, 老年人, 上臂远端骨折

Abstract: Objective To compare the safety and clinical efficacy of different concentrations of ropivacaine by ultrasound-guided costoclavicular brachial plexus block (CBPB) or ultrasound-guided axillary brachial plexus block (ABPB) in the elderly patients with bilateral distal arm fracture. Methods A total of 80 elderly patients with bilateral distal arm fracture were selected. All the patients were stratified by gender and randomly divided into A1 group, A2 group, B1 group and B2 group. A1 group received CBPB under ultrasound guidance with 0.25% ropivacaine 0.5 mL/kg; A2 group received CBPB under ultrasound guidance with 0.1875% ropivacaine 0.5 mL/kg; B1 group received ABPB under ultrasound guidance with 0.25% ropivacaine 0.5 mL/kg; B2 group received ABPB under ultrasound guidance with 0.1875% ropivacaine 0.5 mL/kg. The block operation time, needle adjustment times, onset time, block rate of sensory nerve and motor nerve, adverse reactions and postoperative satisfaction of the patients in the four groups were recorded and compared. Results Compared with A1 group, the operation time, the onset time of the radial nerve and musculocutaneous nerve in B1 and B2 group were prolonged, and the frequency of needle adjustment was increased (P<0.01); The onset time of each branch in A2 group was prolonged (P<0.05 or P<0.01). Compared with A2 group, the operation time and radial nerve onset time of B1 and B2 group were prolonged, the ulnar nerve onset time was shortened, and the frequency of needle adjustment was increased (P<0.01). The block rates of sensory nerve and motor nerve in each branch of A1 group were significantly higher than those of B2 group (P<0.05); There was no significant difference in the block rate of sensory nerve or motor nerve between A1 group and A2 group (P>0.05). There was no significant difference in the incidence rate of adverse reactions among the four groups (P>0.05). The patients’ satisfaction of A1 and A2 group was significantly higher than that of B1 and B2 group (P<0.01). Conclusions Compared with ABPB, the elderly patients with bilateral distal arm fracture receiving ultrasound-guided CBPB with 0.1875% ropivacaine (0.5 mL/kg) show short operation time, less needle adjustment times, good nerve block effect and high patient’s satisfaction, and satisfactory clinical effect.

Key words: costoclavicular brachial plexus block, axillary brachial plexus block, ropivacaine, aged, fracture of distal upper limb

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