超声引导臂丛上干单点注射复合颈浅丛阻滞在老年患者锁骨内固定手术中的应用.docVIP

超声引导臂丛上干单点注射复合颈浅丛阻滞在老年患者锁骨内固定手术中的应用 　　摘要：目的 超声引导下行臂丛神经上干单点注射复合颈浅丛阻滞，观察其在老年患者锁骨内固定手术时的麻醉效果。方法 择期行锁骨内固定术的老年患者22例，超声实时引导下行臂丛神经上干单点注射复合颈浅丛阻滞，局麻药为0.4%罗哌卡因，其中臂丛上干20 ml，颈浅丛10 ml。观察麻醉效果（优、良、差），记录术中阿片类药物的使用以及并发症的发生。结果 22例患者均在神经阻滞下完成手术，麻醉效果优秀18例，良好4例。无阻滞失败、局麻药中毒、气胸等并发症发生。结论 超声引导下行臂丛神经上干单点注射复合颈浅丛阻滞，麻醉效果可靠，并发症较少，是老年患者锁骨内固定手术较为理想的麻醉方式。 　　关键词：锁骨骨折；超声引导；神经阻滞 　　中图分类号：R6143 文献标志码：A 文章编号：DOI 　　Ultrasound Guided Upper Trunk of Brachial Plexus Block and Superficial Cervical Plexus 　　Block for Clavicular Fracture in Older Patients 　　DONG Min， WU Wen-chun， CAO Ya-jun， DENG Xiao-zhen， LV Hong-wei 　　（Department of Anesthesia， Xiangyang Traditional Chinese Medicine Hospital Affiliated to Hubei University of Traditional Chinese Medicine， Xiangfan 441000，Hubei，China） 　　Abstract：Objective To evaluate the efficacy of ultrasound-guided combined upper trunk of brachial plexus and superficial cervical plexus block in older patients undergoing clavicle surgery.Methods Totall 22 ASA II～Ⅳ older patients were scheduled for clavicle surgery，injecte with 20 ml 0.4% ropivacaine at upper trunk of brachial plexus and 10 ml at superficial cervical plexus by ultrasound guid. Observed the effect（excellent， good and failure） and complications of block. Recorded the dosage of Fentanly during the operation. Results All 22 patients completed the operation by the nerve block. The effect of block is excellent in 18 cases and good in 4 cases.No complications such as vascular puncture，toxic reaction and pneumothorax oceurred. Conclusion It is reliable that block the upper trunk of brachial plexus and superficial cervical plexus by ultrasound-guid in older patients undergoing clavicle surgery. 　　Key words：Clavicular fracture； Ultrasound-guid； Nerve block 　　锁骨内固定是临床常见手术，多采用肌间沟臂丛阻滞或者颈丛阻滞的麻醉方式。由于手术区域受双重神经支配，单独的肌间沟或者颈丛阻滞常难以获得完善效果。另一方面传统解剖标志定位下的神经阻滞存在一定的失败率，容易出现血管损伤、局麻药中毒等并发症。超声引导可以对周围神经进行精确定位，实时监测局麻药扩散，提高了神经阻滞的成功率[1-3]。自2014年3月～12月期间，我院共有22例锁骨骨折的老年患者在超声引导下行臂丛神经上干单点注射复合颈浅丛阻滞，手术经过顺利，现将病例报道如下。 　　1 资料与方法 　　1.1