天津医药

天津医药

• 临床研究 • 上一篇    下一篇

超声引导下臂丛与颈深丛联合神经阻滞在 肩关节镜手术中的应用

谢淑华 1，2，丁玲 2，魏颖 2，耿立成 2，王国林 1△   

  1. 1天津医科大学总医院麻醉科（邮编300052）；2天津市人民医院麻醉科
  • 出版日期:2018-07-15 发布日期:2018-07-15
  • 作者简介:谢淑华（1981），男，博士在读，主要从事临床麻醉研究

Application of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery

XIE Shu-hua1,2, DING Ling2, WEI Ying2, GENG Li-cheng2, WANG Guo-lin1△   

  1. 1 Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; 2 Department of Anesthesiology, Tianjin Union Medical Centre △Corresponding Author E-mail: wang_guolin@hotmail.com
  • Published:2018-07-15 Online:2018-07-15

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摘要： 目的 研究超声引导下臂丛与颈深丛联合神经阻滞在肩关节镜手术中应用的效果。方法 60例择期行 肩关节镜手术患者随机分为全麻组（GA组）和神经阻滞组（NA组），每组30例。GA组患者常规全身麻醉，NA组患者 采用超声引导下肌间沟入路臂丛神经阻滞+颈深丛阻滞。观察记录2组患者术中血流动力学情况，术后首次进食水 时间，首次下地活动时间，麻醉总费用，平均住院时间，患者麻醉满意度评分，手术医生麻醉满意度评分，术后2、4、8、 12 h时视觉模拟评分（VAS），需要额外镇痛药物患者比例，术后24 h不良反应。结果 2组患者性别构成、年龄、体质 量指数、手术时间，术中收缩压、舒张压和平均动脉压、心率最低值，患者术中麻醉满意度、手术医师术中麻醉满意 度，术后12 h VAS评分≤3分比例、需要额外应用镇痛药物比例差异均无统计学意义（P＞0.05）。NA组患者术中收缩 压、舒张压和平均动脉压、心率最高值均低于GA组，术后首次进食水时间、首次下地活动时间明显短于GA组，术后 不良反应发生率显著低于GA组，麻醉总费用和平均住院时间显著低于GA组，术后2、4、8 h VAS评分≤3分比例显著 高于GA组，需要额外应用镇痛药物患者比例显著低于GA组（均P < 0.05）。结论 超声引导下完善的臂丛联合颈深 丛神经阻滞是肩关节镜手术麻醉的一种可靠选择，能够促进患者快速康复。

关键词: 麻醉, 全身, 臂丛, 颈丛, 超声引导, 神经阻滞, 肩关节镜手术

Abstract: Objective To evaluate the effect of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery. Methods A total of 60 cases under shoulder arthroscopic surgery were randomly divided into two groups: general anesthesia group (GA) and nerve block group (NA), with 30 cases in each group. Patients of group GA were given general anesthesia, and patients of group NA were given ultrasound guided brachial plexus block with deep cervical plexus nerve block. Data of the haemodynamics of patients, the time for the first feeding of water after operation, ambulation postoperation, the total cost of anesthesia, the average hospitalization days, the satisfaction of anesthesia in patients and surgeons, the pain scores (VAS) at 2, 4, 8, 12 h postoperation, the proportion of patients that needed additional analgesic drugs and the adverse events in 12 h postoperation were all recorded. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative systolic pressure, diastolic pressure and mean arterial pressure, the minimum heart rate, the satisfaction of anesthesia in patients and surgeons, the proportion of postoperative 12 h VAS score ≤ 3 and the need for additional analgesic drugs between two groups of patients (P＞0.05). In group NA, the intraoperative systolic pressure, diastolic pressure and mean arterial pressure and the maximum heart rate were lower than those in group GA. The time of the first feeding water, and ambulation post operation were shorter in group NA than those of group GA. The incidence of adverse reactions was significantly lower in group NA than that in group GA. The total anesthesia cost and the average hospitalization days were significantly lower in group NA than those of group GA. The proportion of postoperative VAS score ≤ 3 at 2, 4 and 8 h was higher in group NA than that of group GA. The proportion of patients needed additional analgesic drugs was significantly lower in group NA than that of GA group (P < 0.05). Conclusion Ultrasound-guided brachial plexus combined with deep cervical plexus nerve block is a reliable choice for shoulder arthroscopic surgery, which can promote the rapid rehabilitation of patients.

Key words: anesthesia, general, brachial plexus, cervical plexus, ultrasound guided, nerve block, shoulder arthroscopy