CAJ | 학술논문

目的：探讨双腔喉罩复合臂丛神经阻滞（肌间沟）对老年患者锁骨骨折手术的影响。方法选择60例年龄60~80岁拟行锁骨骨折内固定术患者，随机分成A、B、C三组，每组20例。A组：使用气管插管全麻；B组：使用臂丛神经阻滞（肌间沟）复合同侧颈浅神经丛阻滞麻醉；C组：使用双腔喉罩插管复合臂丛神经阻滞麻醉。观察并记录患者入室后5 min（T1）、麻醉操作后（T2）、手术开始时（T3）、手术结束时（T4）的心率（HR）、血压（BP）、血氧饱和度（SpO2）的变化，以及三组患者术后并发症的发生情况和视觉模拟评分（ VAS）情况。结果与T1时刻比较，A组患者在T2，T3， T4时刻的HR、BP有显著升高，明显波动（ P <0.05），B组与C组患者在T2，T3，T4时刻的HR、BP无显著性差异（ P >0.05）。三组患者各时间点SpO2无明显差异（ P >0.05）。A组、B组、C组术后不良反应发生率为55.0%、40.0%和20.0%。A组、B组不良反应发生率均明显高于C组，差异具有显著性（ P <0.05）。C组患者VAS评分明显低于A组患者（ P <0.05），与B 组患者VAS评分差异无显著性（ P >0.05）。结论双腔喉罩复合臂丛神经阻滞用于老年锁骨骨折内固定手术，麻醉效果确切，不良反应小，安全可靠。
목적：탐토쌍강후조복합비총신경조체（기간구）대노년환자쇄골골절수술적영향。방법선택60례년령60~80세의행쇄골골절내고정술환자，수궤분성A、B、C삼조，매조20례。A조：사용기관삽관전마；B조：사용비총신경조체（기간구）복합동측경천신경총조체마취；C조：사용쌍강후조삽관복합비총신경조체마취。관찰병기록환자입실후5 min（T1）、마취조작후（T2）、수술개시시（T3）、수술결속시（T4）적심솔（HR）、혈압（BP）、혈양포화도（SpO2）적변화，이급삼조환자술후병발증적발생정황화시각모의평분（ VAS）정황。결과여T1시각비교，A조환자재T2，T3， T4시각적HR、BP유현저승고，명현파동（ P <0.05），B조여C조환자재T2，T3，T4시각적HR、BP무현저성차이（ P >0.05）。삼조환자각시간점SpO2무명현차이（ P >0.05）。A조、B조、C조술후불량반응발생솔위55.0%、40.0%화20.0%。A조、B조불량반응발생솔균명현고우C조，차이구유현저성（ P <0.05）。C조환자VAS평분명현저우A조환자（ P <0.05），여B 조환자VAS평분차이무현저성（ P >0.05）。결론쌍강후조복합비총신경조체용우노년쇄골골절내고정수술，마취효과학절，불량반응소，안전가고。
Objective To explore the effect of combined ProSeal laryngeal mask airway with brachial plexus block( interscalene)on eld-erly patients undergone the operation of the fracture of the clavicle. Methods A total of 60 patients with the age of 60~80 were selected and di-vided into three groups,each group 20 patients. Group A:patients who need the operation of the fracture of the clavicle received the tracheal intu-bation anesthesia;Group B:patients who need the operation of the fracture of the clavicle received the brachial plexus block( interscalene )and ipsilateral superficial cervical block;Group C:patients who need the operation of the fracture of the clavicle received ProSeal laryngeal mask intu-bation anesthesia and brachial plexus block. Three indexes including HR,BP,SpO2 have been examined at five time-points:before entering op-erating room(T1),after anesthesia operation(T2),beginning of the operation(T3),after the operation(T5). The postoperative complications have also been monitored. And all patients could receive the visual analogue scale. Results Compared with T1 time-point,HR and BP have significantly difference at T2,T3,T4 in group A( P <0. 05);and HR and BP don't have significantly difference at T2,T3,T4 in both group B and C( P >0. 05). The adverse reaction rate after operation in Group A,Group B,Group C was respectively 55. 0%,40. 0% and 20. 0%. Group A, Group B were significantly higher than group C( P <0. 05)The VAS of patients in group C was significantly lower than those patients in group A ( P <0. 05),but there was no significant difference between group B and C. Conclusion ProSeal laryngeal mask airway combined with brachial plexus block( interscalene )is a new anesthesia approach for the surgery of agedness clavicular fracture. The approach is convenient,practical, safe and reliable with a significance of anesthesia effect.