超声引导下臂丛联合胸椎旁阻滞对肩胛骨骨折内固定患者术后镇痛效果的影响

发布时间：2018-08-20 08:53

【摘要】：目的评价超声引导下臂丛联合胸椎旁阻滞(thoracic paravertebral block,TPVB)对肩胛骨骨折内固定患者术后镇痛效果的影响。方法选择择期肩胛骨骨折内固定患者60例,男48例,女12例,ASAⅠ或Ⅱ级,随机分为臂丛联合TPVB组(B组)和对照组(C组),每组30例。B组患者通过肌间沟和锁骨上两条途径予以臂丛神经阻滞,并在C_7~T_1、T_2~T_3和T_4~T_5水平予以椎旁阻滞,阻滞完成30min后行全麻诱导。C组常规全麻诱导手术。记录患者术中舒芬太尼用量、PACU停留时间、疼痛主诉、追加镇痛药物等情况;观察并记录术后恶心呕吐、眩晕、呼吸抑制、尿潴留等并发症。结果 C组术中舒芬太尼用量明显多于B组[(43.2±7.1)μg vs(12.3±5.2)μg,P0.05];PACU停留时间明显长于,主诉疼痛比例和芬太尼追加剂量明显大于B组(P0.05);两组术后并发症差异无统计学意义。结论超声引导下臂丛联合TPVB在肩胛骨骨折内固定患者的术后镇痛中,效果确切,安全可靠。
[Abstract]:Objective to evaluate the effect of ultrasound guided brachial plexus combined with paraspinal thoracic block (thoracic paravertebral block on postoperative analgesia in patients with scapular fracture. Methods A total of 60 patients (48 males and 12 females) with selective internal fixation of scapular fractures were enrolled in this study. The brachial plexus combined with TPVB group (group B) and control group (group C) were randomly divided into two groups: group B (n = 30). Group B received brachial plexus nerve block through intermuscular sulcus and supraclavicular nerve block, and paravertebral block was performed at C7T _ 1T _ (1) T _ 2T _ (2) T _ (3) and T_4~T_5 level. General anesthesia induction was performed in group C after complete 30min block. The duration of stay of PACU, the main complaint of pain, the addition of analgesic drugs were recorded, and the postoperative complications such as nausea and vomiting, vertigo, respiratory depression and urinary retention were observed and recorded. Results the dosage of sufentanil in group C was significantly longer than that in group B [(43.2 卤7.1) 渭 g vs (12.3 卤5.2 渭 g / g P05], and the proportion of main complaint pain and the additional dose of fentanyl in group C were significantly higher than those in group B (P0.05), and there was no significant difference in postoperative complications between the two groups. Conclusion Ultrasound guided brachial plexus combined with TPVB is effective, safe and reliable in postoperative analgesia of patients with scapular fracture.
【作者单位】：上海交通大学附属第六人民医院麻醉科;
【分类号】：R614

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