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

摘要：

目的　探讨超声引导下阿芬太尼肌间沟臂丛神经阻滞的麻醉效果及对患者血流动力学、应激反应的影响。方法　选取南阳医学高等专科学校第一附属医院2020年3月至2021年5月收治的80例上肢骨折手术患者进行随机对照试验。采用抽签法将入组患者分为研究组（41例）与对照组（39例）。研究组男22例，女19例，年龄（48.42±3.38）岁。对照组男21例，女18例，年龄（48.89±3.53）岁。两组均接受超声引导下肌间沟臂丛神经阻滞麻醉，对照组采用罗哌卡因，研究组采用阿芬太尼。对比麻醉不同时间动脉血氧饱和度（SaO₂）、一氧化氮（NO）、平均动脉压（MAP）、肾上腺皮质激素（ACTH）、心率（HR）、超氧化物歧化酶（SOD）及疼痛评分［视觉模拟评分法（VAS）］。采用t检验。结果　阻滞前，两组HR、SaO₂、MAP差异均无统计学意义（t=0.191、0.182、0.020，均P>0.05）；阻滞后30 min，研究组SaO₂［（0.993 5±0.106 2）比（0.874 5±0.048 0）］、MAP［（90.50±10.21）mmHg（1 mmHg=0.133 kPa）比（83.45±9.68）mmHg］均高于对照组，HR［（69.05±8.43）次/min比（74.59±8.31）次/min］低于对照组（t=5.527、2.875、4.803，均P<0.05）。术前1 d，两组SOD、ACTH、NO差异均无统计学意义（t=0.937、0.984、0.071，均P>0.05）；术后3 d，研究组SOD、ACTH、NO均低于对照组（t=7.589、3.989、5.319，均P<0.05）。研究组术后1.0 h VAS评分高于对照组（t=2.980，P<0.05）；两组术后0.5、3.0、24.0、72.0 h VAS差异均无统计学意义（t=0.617、1.077、0.349、0.705，均P>0.05）。结论　采用阿芬太尼进行超声引导下肌间沟臂丛神经阻滞可在有效改善患者术后疼痛、避免术后应激的同时，维持其术中血流动力学稳定，具有较高应用价值。

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