广西医学

目的探讨超声引导下经肋锁间隙入路臂丛神经阻滞在上肢骨折手术中的应用效果。方法将80例接受超声引导下臂丛神经阻滞的上肢骨折手术患者随机分成经肋锁间隙入路组(CC组)和经喙突入路组(CA组)，各40例。比较两组患者臂丛神经阻滞情况、术后镇痛情况及不良反应发生情况。结果 CC组患者臂丛神经阻滞穿刺深度浅于CA组，阻滞操作时间和起效时间短于CA组(P＜0.05)；除神经阻滞操作结束后5 min及30 min外的其他时间点，CC组的综合阻滞成功率高于CA组(P＜0.05)。术后12 h、18 h、24 h、36 h，CC组患者静息状态及运动状态下的疼痛视觉模拟量表评分低于CA组(P＜0.05)。两组不良反应总发生率差异无统计学意义（P＞0.05）。结论将超声引导下经肋锁间隙入路臂丛神经阻滞应用于上肢骨折手术中，具有操作简便、起效快、镇痛效果好、不良反应发生率低等优点。

ObjectiveTo investigate the application effect of ultrasound-guided brachial plexus block via costoclavicular space approach in upper extremity fracture surgery. MethodsA total of 80 patients receiving upper extremity fracture surgery of ultrasound-guided brachial plexus block were randomly divided into via costoclavicular space approach group (CC group) or via coracoid approach group (CA group), with 40 cases in each group. Status of brachial plexus block, postoperative analgesia conditions, occurrence of postoperative adverse reactions were compared between patients of the two groups. ResultsThe CC group exhibited shallower puncture depth of brachial plexus block as compared with the CA group, shorter block operation duration and onset time as compared with the CA group (P＜0.05); moreover, higher successful rates of comprehensive block in various time points except for 5 and 30 minutes after nerve block operation as compared with the CA group (P＜0.05). After 12, 18, 24, and 36 hours of operation, the CC group yielded lower Visual Analogue Scale score for pain in resting state and motor state as compared with the CA group (P＜0.05). There was no statistically significant difference in the total incidence rate of adverse reactions between the two groups (P＞0.05). ConclusionEmploying ultrasound-guided brachial plexus block via costoclavicular space approach in upper extremity fracture surgery has advantages of easy and simple operation, rapid onset, favorable analgesic effect, and a low incidence rate of adverse reactions, etc.