肌间沟联合腋路与单纯肌间沟臂丛神经阻滞对老年肱骨骨折患者麻醉效果的影响

Effects of combined interscalene-axillary brachial plexus block and simple interscalene brachial plexus nerve block on anesthetic efficacy in elderly patients with humeral fractures

中文关键词: 老年  肱骨骨折  超声引导  肌间沟臂丛神经阻滞  腋路臂丛神经阻滞

英文关键词: elderly  humeral fracture  ultrasound guidance  interscalene brachial plexus block  axillary brachial plexus block

中文摘要:

      目的 探讨超声引导下肌间沟联合腋路臂丛神经阻滞在老年肱骨骨折手术中的麻醉效果及其临床应用价值.方法 选取2021年11月至2024年7月期间收治的110例老年肱骨骨折手术患者,随机分为对照组(n=55)和联合组(n=55),对照组接受单纯肌间沟臂丛神经阻滞,联合组接受肌间沟联合腋路臂丛神经阻滞.比较两组患者手术与麻醉指标、血流动力学和生命体征指标、应激指标变化情况,以及不良反应发生率.结果 联合组操作耗时为(10.26±1.57)min,显著长于对照组的(6.14±1.33)min,但联合组患者感觉丧失起效时间和运动功能丧失起效时间分别为(40.78±5.29)s和(130.46±16.75)s,均短于对照组,联合组的感觉和运动阻滞持续时间也明显更长,差异均有统计学意义(P＜0.05).麻醉过程中,联合组在麻醉后15、30、60 min时的平均动脉压和心率变化幅度小于对照组,且术后皮质醇和促肾上腺皮质激素水平升高幅度低于对照组,差异均有统计学意义(P＜0.05).联合组不良反应发生率为5.45％,显著低于对照组的23.64％,差异有统计学意义(P＜0.05).结论 超声引导下的肌间沟联合腋路臂丛神经阻滞技术相较于单纯肌间沟阻滞,在老年肱骨骨折手术中表现出更好的麻醉效果,包括更快的起效时间、更长的阻滞持续时间、更稳定的血流动力学状态和更低的不良反应发生率,具有较高的临床应用价值.

英文摘要:

      Objective To investigate the anesthetic efficacy and clinical application value of ultrasound-guided interscalene brachial plexus block combined with axillary approach brachial plexus block in elderly patients undergoing humeral fracture surgery.Methods A total of 110 elderly patients scheduled for humeral fracture surgery between November 2021 and July 2024 were selected and randomly divided into control group(n=55)and combined group(n=55).The control group received interscalene brachial plexus block alone,while the combined group received a combination of interscalene and axillary approach brachial plexus blocks.The surgical and anesthetic parameters,hemodynamic and vital sign indicators,stress indicators,and the incidence of adverse reactions were compared between the two groups.Results The operation time in the combined group was significantly longer(10.26±1.57 min)than the control group(6.14±1.33 min).However,the onset time of sensory loss(40.78±5.29 s)and motor function loss(130.46±16.75 s)in the combined group were significantly shorter than those in the control group.The durations of both sensory and motor blockade in the combined group were also significantly longer(all P＜0.05).During the anesthesia process,the changes in mean arterial pressure and heart rate in the combined group at 15,30,and 60 minutes after anesthesia were smaller than those in the control group,and the postoperative increases in the levels of cortisol and adrenocorticotropic hormone in the combined group were significantly lower than those in the control group(all P＜0.05).The incidence of adverse reactions in the combined group(5.45％)was significantly lower than that in the control group(23.64％)(P＜0.05).Conclusion Compared to interscalene block alone,ultrasound-guided combined interscalene and axillary brachial plexus blockade may provide superior anesthetic effects for humeral fracture surgery in elderly patients,including faster onset time,longer block duration,more stable hemodynamic status,and lower incidence of adverse reactions.It has high clinical application value.