| 摘要: |
| 目的：探讨超声引导下重症老年患者以锁骨上径路臂丛神经阻滞为基础的麻醉管理方案的有效性和安全性。
方法：选择年龄60岁以上，ASA Ⅲ∽Ⅳ级，体重指数18.6～24.9 kg·m－2，上肢骨折择期手术拟行锁骨上臂丛阻滞者32例，男女各16例，按年龄段分组，A组60-74岁，B组75岁以上。经便携式超声定位仪于锁骨上窝扫描臂丛神经，采用“平面内”技术在超声图像的引导下调整进针角度及深度，分三针注入罗哌卡因 右美托咪啶局麻药25—30ml满意包裹神经丛,辅以合适的镇静、镇痛、血管活性药物维护重要脏器功能。
结果：所有患者均按照既定计划完成麻醉，未出现因麻醉效果欠佳而中途转为全身麻醉者，术中镇静评分、合作评分、麻醉效果评分均满意，术后12小时内未见明显术后并发症发生。
结论：超声引导下重症老年患者以锁骨上径路臂丛神经阻滞为基础的麻醉管理方案，不仅能满足术中手术需要，而且能有效预防术后并发症的发生。 |
| 关键词: 超声引导，锁骨上臂丛神经阻滞，老年，上肢骨折 |
| DOI： |
| 投稿时间：2016-03-04修订日期：2016-04-04 |
| 基金项目: |
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| Application Experience of Ultrasound-guided Supraclavicular Brachial Plexus Block in Critical Elderly Patients with the Upper Limbs Fracture Surgery Anesthesia |
| xutianhua |
| () |
| Abstract: |
| Objective： To explore the efficacy and safety of the anesthesia management scheme that on the basis of Ultrasound- guided supraclavicular brachial plexus block in critical elderly patients with upper limbs fracture surgery.
Methods: Thirty-two American Society of Anesthesiologists (ASA) class, Ⅲ or Ⅳ patients scheduled for elective upper limb fracture operation under ?supraclavicular brachial plexus block?, age over 60 years old,Body mass index(BMI) 18.6～24.9 kg·m－2. Each 16 cases of men and women, were divided into two groups according to the age. A group of 60-74 years old, B group of more than 75 - year – old. Portable ultrasound device scan brachial plexus in the supraclavicular fossa, adjusting the Angle of the needle and depth under the guidance of ultrasound images. Ropivacaine Dexmedetomidine local anesthetics 25-30 ml injected around the nerves by three times. Then, supplemented by appropriate sedation, analgesia, vascular active drug to maintenance important viscera function.
Results: All patients were completed anesthesia according to the established plan, and didn’t carry out general anesthesia because of the inefficiency of anesthesia.
During operation, sedation score、cooperation score、anaesthesia effect is satisfactory，
Obvious postoperative complications were not observed after 12 hours.
Conclusion: On the basis of the anesthesia management plan of ultrasound-guided supraclavicular brachial plexus block in critically ill elderly patients with upper limbs fracture surgery, not only can meet the needs of the intraoperative surgical, and can effectively prevent the occurrence of postoperative complications. |
| Key words: Guided by ultrasound, Supraclavicular brachial plexus block, Ropivacaine, Old age, Upper limb fracture, |
