关键词:

上肢骨折, 超声, 阿芬太尼, 肌间沟臂丛神经阻滞, 血流动力学

Abstract:

Objective　To investigate the anesthetic effect of alfentanil in intermuscular sulcus brachial plexus block guided by ultrasound and its influence on the patients' hemodynamics and stress response. Methods　Eighty patients with upper limb fracture who were treated at First Hospital, Nanyang Medical College from March 2020 to May 2021 were selected for the randomized controlled trial. The patients were divided into a study group (41 cases) and a control group (39 cases) by lottery. There were 22 males and 19 females in the study group; they were (48.42±3.38) years old. There were 21 males and 18 females in the control group; they were (48.89±3.53) years old. Both groups received ultrasound guided intermuscular sulcus brachial plexus block anesthesia; the control group used ropivacaine; the study group used alfentanil. The arterial oxygen saturations (SaO₂), nitric oxide (NO), mean arterial pressures (MAP), adrenocortical hormone (ACTH), heart rates (HR), superoxide dismutase (SOD), and pain scores [Visual Analogue Scale (VAS)] were compared at different times of anesthesia. t test was applied. Results　There were no statistical differences in HR, SaO₂, and MAP between the two groups before the block (t=0.191, 0.182, and 0.020; all P>0.05); 30 minutes after the block, the SaO₂ [(0.993 5±0.106 2) vs. (0.874 5±0.048 0)] and MAP [(90.50±10.21) mmHg (1 mmHg=0.133 kPa) vs. (83.45±9.68) mmHg] in the study group were higher than those in the control group, and the HR [(69.05±8.43) beats/min vs. (74.59±8.31) beats/min] was lower than that in the control group (t=5.527, 2.875, and 4.803; all P<0.05). There were no statistical differences in SOD, ACTH, and NO between the two groups one day before the operation (t=0.937, 0.984, and 0.071; all P>0.05); three days after the operation, the SOD, ACTH, and NO in the study group were lower than those in the control group (t=7.589, 3.989, and 5.319; all P<0.05). The VAS score of the study group was higher than that of the control group 1.0 hour after the operation (t=2.980; P<0.05); there were no statistical differences in the VAS scores 0.5, 3.0, 24.0, and 72. hours after the operation between the two groups (t=0.617, 1.077, 0.349, and 0.705; P>0.05). Conclusion　Ultrasound guided intermuscular sulcus brachial plexus block with alfentanil can effectively reduce the patients' stress response and postoperative pain and keep their hemodynamics stable during operation, so it has high application value.

Key words:

Upper limb fracture, Ultrasound, Alfentanil, Intermuscular sulcus brachial plexus block, Hemodynamics