肌间沟入路与腋路臂丛神经阻滞在老年桡骨远端骨折手术中的麻醉效果对比

许春城

【摘要】 目的：分析肌间沟入路与腋路臂丛神经阻滞对老年桡骨远端骨折手术患者的影响。方法：回顾性分析本院2016年10月-2017年12月治疗的老年桡骨远端骨折手术患者86例采取超声引导下臂丛神经阻滞麻醉的骨折患者的临床资料，根据不同入路分为对照组（41例）与观察组（45例）。对照组采取肌间沟入路臂叢神经阻滞，观察组采取腋路臂丛神经阻滞。比较两组支配术区神经的痛觉消失时间、麻醉效果、操作时间、镇痛持续时间及并发症发生情况。结果：两组尺神经、正中神经、前臂内侧皮神经的痛觉消失时间比较，差异均有统计学意义（P<0.05）。观察组麻醉效果优于对照组，差异有统计学意义（P<0.05）。两组操作时间、镇痛持续时间比较，差异均无统计学意义（P>0.05）。两组并发症发生率比较，差异无统计学意义（P>0.05）。结论：腋路臂丛神经阻滞对老年桡骨远端骨折手术患者的麻醉效果优于肌间沟入路臂丛神经阻滞，前者的神经阻滞更完全，且并发症发生少，值得研究应用。

【关键词】 肌间沟入路； 腋路； 臂丛神经阻滞； 桡骨远端骨折

Comparison of Anesthetic Effects between Intermuscular Sulcus Approach and Axillary Brachial Plexus Block in Elderly Patients with Distal Radial Fractures/XU Chuncheng.//Medical Innovation of China，2018，15（14）：123-126

【Abstract】 Objective：To analyze the effect of intermuscular sulcus approach and axillary brachial plexus block on elderly patients with distal radius fracture.Method：A total of 86 patients undergoing ultrasound-guided brachial plexus block surgery for elderly patients with distal radius fractures in our hospital from October 2016 to December 2017 were selected，they were divided into control group（41 cases）and observation group（45 cases）according to different anesthesia method.The control group was treated with brachial plexus block via intermuscular sulcus approach，axillary brachial plexus block was used in the observation group.The extinction time of pain sense，anesthetic effect，operation time，duration of median analgesia and complication were compared between the two groups.Result：The time of pain disappearance of ulnar nerve，median nerve and medial forearm cutaneous nerve were significantly differences between the two groups（P<0.05）.The effect of anesthesia in the observation group was better than that in the control group， the difference was statistically significant（P<0.05）.There were no significant differences in operation time and analgesic duration between the two groups（P>0.05）.There was no significant difference in the incidence of complications between the two groups（P>0.05）.Conclusion：The anesthetic effect of axillary brachial plexus block on elderly patients with distal radial fracture is better than that of intermuscular sulcus approach. The former has more complete nerve block and fewer complications， so it is worthy of study and application.

【Key words】 Intermuscular sulcus approach； Axillary approach； Brachial plexus block； Distal radial fracture

First-authors address：Puning Peoples Hospital，Puning 515300，China

doi：10.3969/j.issn.1674-4985.2018.14.030

桡骨远端骨折多发于年龄较大的患者，针对此类患者的麻醉方案，应尽可能地减少麻醉药用量，减小麻醉对机体的影响[1]。对比全身麻醉，臂丛神经阻滞的麻醉针对性显著增大，在超声引导下可进一步提高穿刺准确性，最大限度减小穿刺损伤程度[2]。目前临床学者普遍认为臂丛神经阻滞在桡骨远端骨折手术麻醉中占主导地位，且肌间沟入路臂丛神经阻滞的操作较为简便，操作时间短于其他入路的臂丛神经阻滞，镇痛持续时间满足患者的手术需要，得到临床的认可[3]。但……