3种麻醉方式在锁骨内固定术中临床应用的效果观察

发布时间：2018-04-16 11:11

本文选题：内固定术 + 颈丛　；参考：《浙江创伤外科》2016年06期

【摘要】：目的观察3种神经阻滞麻醉方法在锁骨内固定术中的应用效果。方法从2013年1月至2014年7月就医的锁骨骨折患者中选取327例,随机分为3组,每组均为109例,分别使用三种不同的麻醉方法,观察其麻醉效果。A组患者行颈丛C4一点法加C6颈浅丛阻滞,依照颈丛一点法,患者平卧头偏向健侧,使用局麻药0.375%的罗哌卡因,C4浅丛、深丛和C6浅丛分别注射药物6ml。B组采用肌间沟臂丛神经阻滞,患者平卧头偏向健侧,采用肌间沟法,注射局麻药0.375%的罗哌卡因20~25ml。C组患采用肌间沟臂丛神经阻滞加颈浅丛神经阻滞,首先采用肌间沟法注入局麻药0.375%的罗哌卡因15~20ml,阻滞肌间沟臂丛神经,5~10分钟后观察效果,肌间沟臂丛阻滞麻醉效果达成后即行颈丛浅支阻滞麻醉,采用颈丛一点法注入局麻药10~15ml。结果 A、B、C组的优良率分别为80.7%、83.5%和96.3%,C组的优良率明显高于A、B两组差异有统计学意义(P0.05)。结论锁骨骨折内固定术时,采用肌间沟臂丛神经阻滞加颈浅丛神经阻滞麻醉方法 ,能取得最安全最有效的麻醉效果,值得推广应用。
[Abstract]:Objective to observe the effect of three kinds of nerve block anesthesia in clavicle fixation.Methods from January 2013 to July 2014, 327 patients with clavicle fracture were randomly divided into 3 groups, 109 cases in each group, and three different anesthetic methods were used.The anaesthesia effect was observed in group A. patients in group A received cervical plexus C4 one-point block and C6 superficial cervical plexus block. According to the one-point method of cervical plexus, the patient's supine head was inclined to the healthy side, and the local anesthetic 0.375% ropivacaine was used to treat the C4 superficial plexus.Deep plexus and C6 superficial plexus were injected into 6ml.B group by intermuscular sulcus brachial plexus block. The patients with recumbent head were inclined to the normal side. The patients of ropivacaine 20~25ml.C group were treated with intermuscular sulcus brachial plexus block and cervical superficial plexus block by injection of local anesthetic 0.375% ropivacaine 20~25ml.C group, and the patients were treated with intermuscular sulcus brachial plexus block and cervical superficial plexus block.Firstly, the local anesthetic 0.375% ropivacaine 1520ml was injected into the intermuscular groove method. The effect was observed 10 minutes after blocking the intermuscular sulcus brachial plexus nerve. The superficial branch of the cervical plexus was anesthetized immediately after the intermuscular sulcus brachial plexus block was achieved, and the local anesthetic 1015ml was injected into the cervical plexus by one point method of the cervical plexus.Results the excellent and good rates of group A and B were 80.7% and 96.3%, respectively, which were significantly higher than those of group A B (P 0.05).Conclusion the intermuscular sulcus brachial plexus block and cervical superficial plexus block can obtain the safest and most effective anaesthesia effect during clavicle fracture internal fixation, which is worth popularizing.
【作者单位】：浙江省杭州钢铁集团公司职工医院;浙江大学附属第二医院;杭钢医院;
【分类号】：R614

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