New type of nerve block needle in supraclavicular brachial plexus block
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摘要:
目的 探讨新型神经阻滞针在锁骨上臂丛神经阻滞麻醉及术后镇痛应用中的优势。 方法 选择2020年1—5月在延安大学第二附属医院榆林市第一医院择期行桡骨骨折手术的患者60例，ASA Ⅰ~Ⅲ级，采用随机数字表法分为2组，使用普通神经阻滞针行锁骨上臂丛阻滞的对照组(C组，30例)、使用新型神经阻滞针行锁骨上臂丛阻滞的观察组(N组，30例)。在超声引导下，观察2组患者麻醉操作时间、置管成功率、局麻药毒性反应发生率、辅助镇痛药使用剂量、术后镇痛泵使用效果、术后恶心呕吐发生率、围术期神经损伤、穿刺部位有否感染、患者满意度。 结果 超声引导下，C组锁骨上臂丛阻滞操作时间为(9.3±1.6)min，长于N组麻醉操作时间[(6.2±1.1)min]，差异有统计学意义(P < 0.001)。对照组无置管操作，术后镇痛采用静脉镇痛泵PCA。2组患者术后镇痛有效率比较差异有统计学意义(P < 0.001)。术后随访，N组患者恶心呕吐发生率低于C组，差异有统计学意义(P < 0.001)。术毕48 h患者满意度调查，C组评分[(8.2±0.3)分]低于N组[(9.5±0.5)分]，差异有统计学意义(P < 0.001)。2组患者均未发现局麻药毒性反应、神经损伤及穿刺置管部位感染、呼吸抑制等并发症。 结论 新型神经阻滞针行锁骨上臂丛阻滞在桡骨骨折术患者中是更高效、安全的麻醉操作方式，具有更好的术后镇痛效果和患者满意度，为临床提供了借鉴。 Abstract:Objective To explore the advantages of a new type of nerve block needle in supraclavicular brachial plexus block and postoperative analgesia. Methods A total of 60 patients from the Second Affiliated Hospital of Yan'an University, the First Hospital of Yulin, undergoing elective radial fracture surgery, ASAⅠ- Ⅲ were randomly assigned in two different groups: the control group using common nerve block needles (group C, n=30) and the new nerve block needle group (group N, n=30). The outcome measurements included anaesthesia operation time, the success rate of catheterisation, the incidence of local anaesthetic toxicity, the amount of other analgesic drugs used, the postoperative analgesic effect of PCA pump, the incidence of nausea and vomiting, perioperative nerve damage, infection of the puncture site and patient satisfaction. Results Under ultrasonic guidance, the anaesthesia operation time were (9.3±1.6) min in the group C and (6.2±1.1) min in the group N, the difference was significant between the two groups (P < 0.001). No tube was placed in the control group, and intravenous analgesia pump was connected after operation. The VAS score showed a statistically significant difference at 6, 12, 24 and 48 h after surgery. At post-operation follow-up, a significant difference was observed in the incidence of nausea and vomiting between the two groups (P < 0.001). The scores of the patient satisfaction survey 48 h after the operation were (8.2±0.3) in the group C and (9.5±0.5) in the group N (P < 0.001). Infection of the puncture site and incidence of local anaesthetic toxicity, nerve damage and respiratory depression were not observed in both groups. All patients did not receive any other analgesics. Conclusion The new type of nerve block needle for supraclavicular brachial plexus block is confirmed to be a more efficient and safer anaesthesia method that has better postoperative analgesic effect and patient satisfaction, which provides a reference for clinical practice. -
表 1 2组行桡骨骨折手术患者一般情况比较
组别 例数 性别(男/女，例) 年龄(x±s，岁) 体质量(x±s，kg) 手术时间(x±s，min) ASA分级(x±s，分) 普通神经阻滞针组 30 15/15 36.3±5.7 62.5±6.7 46.7±6.4 1.6±0.7 新型神经阻滞针组 30 16/14 38.2±5.9 63.1±7.1 45.5±5.3 1.8±0.6 统计量 0.067a 1.269b 0.337b 0.176b 1.188b P值 0.796 0.209 0.738 0.861 0.237 注：a为χ2值，b为t值。 
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表 2 2组行桡骨骨折手术的患者术前术后各项指标情况
组别 例数 麻醉操作时间(x±s，min) 术后镇痛有效率(%) 患者满意度(x±s，分) 恶心呕吐发生率(%) 普通神经阻滞针组 30 9.3±1.6 80.00(24/30) 8.2±0.3 26.67(8/30) 新型神经阻滞针组 30 6.2±1.1 100.00(30/30) 9.5±0.5 3.33(1/30) 统计量 8.463a 4.630b 12.210a 4.706b P值 < 0.001 0.031 < 0.001 0.030 注：a为t值，b为χ2值。
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