【摘要】 目的:观察臂丛联合颈浅丛神经阻滞应用于锁骨骨折手术中的效果,及对患者血流动力学指标的影响。方法:选取2017年1月～2018年8月在我院接受手术治疗的锁骨骨折患者为研究对象,根据其手术方式分为对照组和观察组,对照组给予臂丛神经阻滞,观察组给予臂丛联合颈浅丛神经阻滞。观察两组患者的血流动力学变化、应激指标和不良反应发生率,比较两组患者手术后VAS得分和镇静效果的差异。结果:两组患者麻醉前血流动力学指标无差别,术中骨折复位时对照组患者的SBP、DBP、MAP水平明显高于麻醉前,观察组与麻醉前无明显统计学差异;两组患者麻醉前应激指标无差别,术中骨折复位时观察组患者的皮质醇、促肾上腺皮质激素水平低于对照组(t=28.531、13.670);观察组患者术后1h和4h的VAS得分低于对照组,两组患者术后Ramsay得分无差别;两组患者术中心动过缓、术后神经损伤和疼痛等不良反应发生率无明显差别。结论:臂丛联合颈浅丛神经阻滞应用于锁骨骨折手术中的麻醉镇痛效果较好,能有效抑制术中应激反应,血流动力学比较稳定,且术后镇痛效果好,具有良好的临床应用价值。更多还原

【Abstract】 Objective To observe the effect of brachial plexus combined with superficial cervical plexus block on clavicular fracture operation and its influence on hemodynamic parameters. Methods The cases of clavicular fracture in our hospital from August 2017 to Jan 2018 Augas the research subjects. According to the operation methods, the patients were divided into the control group and the observation group. The control group was given brachial plexus block, while the observation group was brachial plexus combined with superficial cervical plexus block. Hemodynamic changes, stress indicators and incidence of adverse reactions in the two groups were observed. The difference of VAS score and sedation effect between the two groups after operation were compared. Results There was no difference in hemodynamic parameters before anesthesia between the two groups. The levels of SBP, DBP and MAP in the control group were significantly higher than those before anesthesia. There was no significant difference between the observation group and the pre-anesthesia group. The levels of cortisol and adrenocorticotropic hormone in the observation group were lower than those in the control group(t=28.531, 13.670). The VAS scores of the patients in the observation group were lower than those in the control group at 1 and 4 hours after operation, and there was no difference in Ramsay scores between the two groups. There was no significant difference in the incidence of adverse reactions such as bradycardia, nerve injury and pain between the two groups. Conclusion Brachial plexus combined with superficial cervical plexus nerve block is effective in anesthesia and analgesia in clavicular fracture surgery. It can effectively inhibit intraoperative stress response, has stable hemodynamics, and has good analgesic effect after operation. It has good clinical application value.更多还原