CAJ | 학술논문

目的评价超声引导锁骨手术患者C5和颈浅丛联合阻滞的效果.方法择期拟行锁骨骨折切开复位钢板螺丝钉内固定术患者60例,性别不限,年龄18～64岁,体重指数17.3 ～ 27.6kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):超声引导组(U组)在C5臂丛神经图像的周围注射10 ml局麻药,穿刺针越过C5臂丛神经在胸锁乳突肌下缘再次注射10 ml局麻药.解剖手法定位组(A组)在前、中斜角肌之间的肌间沟行臂丛神经阻滞,注射10 ml局麻药,拔出穿刺针在胸锁乳突肌后缘中点再注射10 ml局麻药.局麻药为0.375％左布比卡因和1％利多卡因的混合液.记录操作时间,锁骨内侧缘、锁骨中点、锁骨外侧缘痛觉消失时间及镇痛时间;评价手术过程中的麻醉效果满意度,观察相关并发症的发生情况.结果与A组比较,U组操作时间延长,锁骨外侧缘、锁骨中点区域痛觉消失时间缩短,麻醉效果满意率升高,镇痛时间延长(P＜0.05).A组刺破血管3例,轻度局麻药中毒1例,U组无相关并发症发生.结论与解剖手法定位比较,超声引导下C5和颈浅丛联合阻滞的麻醉效果较好,对锁骨外侧缘、锁骨中点区域起效快,镇痛时间较长和相关并发症较少.
목적 평개초성인도쇄골수술환자C5화경천총연합조체적효과.방법 택기의행쇄골골절절개복위강판라사정내고정술환자60례,성별불한,년령18～64세,체중지수17.3 ～ 27.6kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법분위2조(n=30):초성인도조(U조)재C5비총신경도상적주위주사10 ml국마약,천자침월과C5비총신경재흉쇄유돌기하연재차주사10 ml국마약.해부수법정위조(A조)재전、중사각기지간적기간구행비총신경조체,주사10 ml국마약,발출천자침재흉쇄유돌기후연중점재주사10 ml국마약.국마약위0.375％좌포비잡인화1％리다잡인적혼합액.기록조작시간,쇄골내측연、쇄골중점、쇄골외측연통각소실시간급진통시간;평개수술과정중적마취효과만의도,관찰상관병발증적발생정황.결과 여A조비교,U조조작시간연장,쇄골외측연、쇄골중점구역통각소실시간축단,마취효과만의솔승고,진통시간연장(P＜0.05).A조자파혈관3례,경도국마약중독1례,U조무상관병발증발생.결론 여해부수법정위비교,초성인도하C5화경천총연합조체적마취효과교호,대쇄골외측연、쇄골중점구역기효쾌,진통시간교장화상관병발증교소.
Objective To evaluate the efficacy of ultrasound-guided combined C5 and superficial cervical plexus block in patients undergoing clavicle surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective clavicle surgery,were randomly divided into 2 groups (n =30 each) using a random number table:injection with 10 ml local anesthetic guided by ultrasound group (group U),and injection with 10 ml local anesthetic guided by anatomical landmark group (group A).A mixture of 0.375 ％ levobupivacaine and 1.0％ lidocaine was used.The time spent performing the block onset time of analgesia,onset time of analgesia in the medial border,midpoint and lateral border of the clavicle and duration of analgesia were measured.The effectiveness of block (excellent,good,failure) was assessed.The complications were observed.Results Compared with group A,the time spent performing the block was significantly prolonged,the onset time of analgesia in the lateral border and midpoint of the clavicle was shortened,the rate of excellent anesthesia was increased,and the duration of analgesia was prolonged in group U (P ＜ 0.05).No complications occurred in group U,while vascular puncture occurred in 3 cases,and one patient developed mild toxic reaction in group A.Conclusion Ultrasound-guided combined C5 and superficial cervical plexus block provides better block,with faster onset time of analgesia in the lateral border and midpoint of the clavicle,longer duration of analgesia and fewer complications as compared with that guided by anatomical landmarks in patients undergoing clavicle surgery.