摘要
目的探讨超声联合神经刺激仪引导下肌间沟臂丛神经阻滞在高血压患者上肢手术中的临床效果。方法选取2018年10月至2020年10月肇庆市高要区人民医院收治的120例经肌间沟臂丛神经阻滞下择期行上肢手术的高血压患者,按照随机综合序贯法将其分为UN组(超声引导+神经刺激仪定位组)、N组(神经刺激仪定位)、T组(传统方法)各40例,比较三组的阻滞操作时间、阻滞起效时间、血流动力学变化、麻醉效果和并发症发生率。结果三组的阻滞操作时间、阻滞起效时间比较,差异有统计学意义(P<0.05),其中UN组的阻滞操作时间(2.27±0.56)min和阻滞起效时间(2.58±0.79)min短于N组的(5.18±1.93)min、(3.85±1.57)min与T组的(8.27±2.64)min和(4.67±2.03)min,差异有统计学意义(P<0.05);三组进入手术室(T0)的平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);手术开始时(T1)、手术开始后10 min(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)、手术后(T5)三组患者的HR、MAP比较,差异有统计学意义(P<0.05);UN组T1、T2、T3、T4、T5的HR高于N组和T组,T1、T2、T3、T4、T5的MAP高于N组,T1、T2的MAP高于T组,T3、T4的MAP低于T组,差异有统计学意义(P<0.05);UN组、N组阻滞成功率(100.00%、92.50%)高于T组(70.00%)(P<0.05),UN组、N组阻滞成功率比较,差异无统计学意义(P>0.05);三组的并发症发生率比较,差异有统计学意义(P<0.05),其中UN组并发症发生率(0.00%)低于N组(22.50%)和T组(47.50%),差异有统计学意义(P<0.05)。结论在高血压患者上肢手术中UN组应用的麻醉方法可有效维持血流动力学稳定,缩短阻滞操作时间和起效时间,降低并发症发生风险。
Objective To explore the clinical effect of intermuscular sulcus brachial plexus block guided by ultrasound combined with nerve stimulator in upper limb surgery of hypertensive patients.Methods A total of 120 hypertensive patients undergoing upper limb surgery under intermuscular sulcus brachial plexus block in People's Hospital of Gaoyao District in Zhaoqing City from October 2018 to October 2020 were selected,and were randomly divided into UN group(ultrasound-guided+nerve stimulator positioning group),N group(nerve stimulator positioning group)and T group(traditional method),with 40 cases in each group.The operation time of block,onset time of block,hemodynamic changes,anesthetic effect and complication rate of the three groups were compared.Results There were significant differences in the operation time of block and onset time of block among the three groups(P<0.05).The operation time and onset time of block in UN group were(2.27±0.56)min and(2.58±0.79)min,respectively,shorter than those in N group[(5.18±1.93)min and(3.85±1.57)min],and T group[(8.27±2.64)min and(4.67±2.03)min],with statistically significant differences(P<0.05).The mean arterial pressure(MAP)and heart rate(HR)of the three groups entering the operating room(T0)showed no significant d ifference(P>0.05).HR and MAP showed statistically significant differences among three groups at the beginning of operation(T1),10 min after operation(T2),30 min after operation(T3),60 min after operation(T4)and after operation(T5),with statistically significant differences(P<0.05).In UN group,HR at T1,T2,T3,T4 and T5 was higher than that of N and T group,while MAP at T1,T2,T3,T4 and T5 was higher than that of T group,and MAP at T3 and T4 was lower than that of T group,with statistically significant differences(P<0.05).The blocking success rate of UN group(100.00%)and N group(92.50%)was higher than that of T group(70.00%)(P<0.05),but there was no significant difference between UN group and N group(P>0.05).There was significant difference in the incidence of complications among the three groups(P<0.05).The incidence of complications in UN group(0.00%)was lower than that in N group(22.50%)and T group(47.50%),with statistically significant difference(P<0.05).Conclusion The anesthesia method applied in upper limb surgery of patients with hypertension in UN group can effectively maintain the hemodynamic stability,shorten the block operation time and onset time,and reduce the risk of complications.
作者
朱海彬
伍素贞
邓秋红
吴耀滨
ZHU Haibin;WU Suzhen;DENG Qiuhong;WU Yaobin(Department of Anesthesiology,People's Hospital of Gaoyao District in Zhaoqing City,Guangdong,Zhaoqing 526000,China)
出处
《中国医药科学》
2021年第22期89-92,111,共5页
China Medicine And Pharmacy
基金
广东省肇庆市科技计划项目(202004030829)。
关键词
超声
神经刺激仪
臂丛神经阻滞
高血压
安全性
上肢手术
Ultrasound
Nerve stimulator
Brachial plexus block
Hypertens ion
Safety
Upper limb surgery
