RESUMO
Objective To explore the application effect and safety of ultrasonic location in interscalene bra-chial plexus block anesthesia.Methods 100 cases with upper extremity orthopedic surgery patients were selected, according to the brachial plexus between the different positioning methods,they were divided into control group and observation group,50 cases in each group,the control group chose the traditional anatomical localization techniques, observation group interscalene under ultrasound guidance brachial plexus block,two groups of anesthesia were com-pared,block success rates and complications were observed.Results The block operation time,anesthesia onset time,duration of analgesia and anesthesia drug dosage of the observation group were (185.5 ±24.86)s,(11.55 ± 2.89)min,(11.42 ±2.39)min,(17.25 ±2.54)mL while the control group were (228.75 ±26.20)s,(16.05 ±4.66)min,(10.95 ±2.83)min,(19.50 ±2.79)mL,there was significant difference between two groups(t =18.34, 10.28,9.72,10.68,all P <0.05).the anesthesia success rate of the observation group was 98%,significantly higher than 88% of the control group,the difference between the two groups was statistically significant(χ2 =9.12,P <0.05).The incidence rate of complications in the observation group was 0,while the control group was 8%,two groups had significant difference in complication rate(χ2 =8.34,P <0.05).Conclusion Ultrasonic location in in-terscalene brachial plexus block anesthesia has a good clinical effect,with high safety,which is worthy of populariza-tion and application.
RESUMO
Objective To retrospectively analyze the importance of preoperative ultrasound and D-dimer determination for patients with traumatic fractures so as to evaluate the value of vascular color Doppler ultrasound in diagnosing of vein thrombosis and the correlation between D-dimer level and lower extremity vein thrombosis. Methods The study involved 1000 in-patients with multiple traumatic fractures, femoral fractures, tibial fractures or tibiofibular fractures admitted from March 2008 to April 2009 who were prepared for open reduction surgery. There were 568 males and 432 females, at age range of 20-90 years ( average 54.8 years). Vein D-dimer was examined in the morning on the second day after admission. Vascular color Doppler ultrasound was performed on the lower extremity one day before operation (after the swelling faded away, about 4-10 days after fracture). Results The vascular color Doppler ultrasound on the lower extremity showed vein thrombosis of the lower extremity in 64 patients (6.4%) including 26 patients with iliac- femoral vein thrombosis, 10 with popliteal-tibial vein thrombosis and 28 with gastrocnemius or soleus muscle vein thrombosis. On the second day after operation, out of 736 patients (73.6%) with D-dimer above normal (324 μg/L), 56 patients (7.6%) developed thrombosis afterwards;of 264 patients (26.4%) with normal D-dimer, eight patients (3.03%) developed thrombsis. Incidence of thrombosis in patients with D-dimer above 650 μg/L was higher than that in patients with D-dimer below 650 μg/L (P＜0. 01). Conclusions Preoperative lower extremity vein Doppler ultrasound in traumatic fracture patients can lower the risk of fatal lung thrombosis caused by existing deep vein thrombosis.D-dimer above normal level indicates tendency of thorombosis. However, normal D-dimer still have the possibility to develop thrombosis, which deserves attention.