| 自控锁骨下臂丛神经阻滞对肘关节三联征术后镇痛及手术疗效的影响 |
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Received:February 15, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王秀珍 |
WANG Xiu-zhen |
宁波市第六医院麻醉科, 浙江 宁波 315040 |
Department of Anesthesiology, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 葛叶盈 |
GE Ye-ying |
宁波市第六医院麻醉科, 浙江 宁波 315040 |
Department of Anesthesiology, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
geyeying59198@163.com |
| 叶光耀 |
YE Guang-yao |
宁波市第六医院麻醉科, 浙江 宁波 315040 |
Department of Anesthesiology, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 张经纬 |
ZHANG Jing-wei |
宁波市第六医院骨科, 浙江 宁波 315040 |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院骨科, 浙江 宁波 315040 |
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| 期刊信息：《中国骨伤》2017年30卷，第11期，第1029-1033页 |
| DOI：10.3969/j.issn.1003-0034.2017.11.012 |
| 基金项目:浙江省医药卫生科研基金项目（编号：2017KY141） |
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目的：观察比较超声引导下自控肌间沟臂丛神经阻滞和自控锁骨下臂丛神经阻滞对肘关节三联征术后镇痛及手术疗效的影响。
方法：采用前瞻性研究方法，2015年3月至2016年8月选择肘关节三联征患者60例，男32例，女28例；年龄16~70岁，平均（55.6±18.2）岁，择期行肘关节三联征内固定术。按照镇痛方式随机分为2组，各30例，分别为自控肌间沟臂丛神经阻滞（C组）和自控锁骨下臂丛神经阻滞镇痛组（I组）。两组患者分别于术前在超声引导下将导管留置在臂丛神经周围，经导管注射0.33%罗哌卡因30 ml。术后全身麻醉苏醒后，连接电子自控镇痛泵。药液配方：0.2%罗哌卡因，背景输注速率5 ml/h，锁定时间15 min，自控镇痛剂量5 ml，镇痛至术后5 d。术后24 h起进行功能锻炼，每日3次，连续5 d。记录术后1、2、3、4、5 d各个时间点静息和进行功能锻炼时VAS评分，术后6 d行肘关节活动度及Mayo肘关节功能评分，并记录术后5 d内导管相关不良反应（渗液、堵塞、脱出等）的发生情况。
结果：两组置管时均阻滞成功。与C组比较，I组静息状态下3 d及术后3、4、5 d功能煅炼时VAS评分降低（2.5±0.5 vs. 3.8±1.1，3.0±0.4 vs. 5.0±0.9，2.5±0.4 vs. 4.5±1.2，2.1±0.3 vs. 4.1±1.0）。术后第6天肘关节活动范围测试及MEPS评分升高：伸肘角度（-2.19±18.01）° vs. （-8.19±12.16）°，屈肘角度（45.15±11.20）° vs. （22.15±7.02）°，旋前角度（19.06±6.75）° vs. （9.10±2.48）°，旋后角度（17.08±5.18）° vs. （10.12±3.15）°，MEPS评分80.80±9.50 vs. 64.90±11.21。C组术后5 d内15例发生渗液，5例导管堵塞，10例导管脱出；I组未见导管和局麻药有关不良反应发生。
结论：自控锁骨下臂丛神经阻滞可有效用于肘关节三联征患者的术后镇痛，并增加其手术疗效。 |
| [关键词]:镇痛,病人控制 神经传导阻滞 疼痛,手术后 肘关节 |
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| Effects of patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow |
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Abstract:
Objective: To study the effects of ultrasound guided inter-scalene brachial plexus block and patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow.
Methods: From March 2015 to August 2016,60 patients with terrible tyriad of the elbows were treated in Ningbo No.6 Hospital with ASAⅠtoⅡinternal fixation. There were 32 males and 28 females,ranging in age from 16 to 70 years old,with a mean age of (55.6±18.2) years old. All the patients were divided into two groups(30 cases in each group):controlled intermuscular groove brachial plexus block (group C),infraclavicular brachial plexus block(group I). All catheters were placed using ultra-sound visualization and injected 0.33% ropivacaine 30 ml preoperatively. After regaining consciousness,all patients connected the electronic pump. The solution contained 0.2% ropiva-caine and the pump was setup to deliver a 5 ml bolus dose,with a 15 min lock out interval and background infusion at 5 ml/h. Both analgesia lasted until 5 d after operation. The patients underwent rehabilitation exercise everyday for 5 consecutive days starting from 24 h after operation.VAS score was recorded at 24 h,48 h,72 h and 4 d,5 d after operation during rest and rehabilitation exercise time. The elbow articular range of motion and Mayo elbow performance score (MEPS) were recorded at 6 d after operation. Catheter-related adversereactions (such as oozing from the insertion site,obstruction,prolapse) were recorded.
Results: The success rate of blockade was 100% during insertion in both groups. Compared with group C,the VAS score at 3 d during rest time and 3,4,5 d after operation during rehabili-tation exercise were decreased(2.5±0.5 vs. 3.8±1.1,3.0±0.4 vs. 5.0±0.9,2.5±0.4 vs. 4.5±1.2,2.1±0.3 vs. 4.1±1.0,P<0.05). The elbow articular range of motion and MEPS were increased(-2.19±18.01)° vs.(-8.19±12.16)°,(45.15±11.20)° vs. (22.15±7.02)°,(19.06±6.75)° vs. (9.10±2.48)°,(17.08±5.18)° vs. (10.12±3.15)°,(80.80±9.50) points vs. (64.90±11.21) points. The incidence of insertion site,obstruction,prolapse was 15,5 and 10 cases respectively in group C,but without any catheter-related adverse reactions happened in group I (P<0.05).
Conclusion: Patient-controlled infraclavieular brachial plexus block can be effectively used for postoperative pain after fixation for terrible tyriad of the elbows,and it can increase surgical outcome. |
| KEYWORDS:Analgesia,patient-controlled Nerve block Pain,postoperative Elbow joint |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王秀珍,葛叶盈,叶光耀,张经纬,马维虎.自控锁骨下臂丛神经阻滞对肘关节三联征术后镇痛及手术疗效的影响[J].中国骨伤,2017,30(11):1029~1033 |
| 英文格式: | WANG Xiu-zhen,GE Ye-ying,YE Guang-yao,ZHANG Jing-wei,MA Wei-hu.Effects of patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(11):1029~1033 |
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