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首页> 中文期刊> 《中国医师杂志》 >超声下臂丛神经加肩胛上神经阻滞复合喉罩全麻在肩关节镜手术中的应用

超声下臂丛神经加肩胛上神经阻滞复合喉罩全麻在肩关节镜手术中的应用

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Objective To investigate the value and advantage of ultrasound guided intermuscular groove and suprascapular nerve block combined with general anesthesia in shoulder arthroscopy.Methods 40 American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ patients undergoing elective arthroscopic shoulder surgery were randomly divided into two groups.Patients in group A were treated with general anesthesia,while patients in group B were treated with brachial plexus and suprascapular nerve block combined with general anesthesia.Mean arterial pressure (MAP),heart rate (HR) and visual analogy score (VAS) were measured at preoperative (To),5 min after the beginning of the surgey (T1),30 min after the beginning of the surgey (T2),at the end of the surgery (T3),and 30 min after removing laryngeal mask (T4).Bispectral index (BIS) was recorded at T1 and T2.The operation time,extubation time,dosage of opioids (sufentanyl),dosage of propofol,visual analogue scale (VAS) scores at awake time in post anesthesia care unit (PACU),and 6 h,12 h,24 h after surgery.Results There were no significant differences in the BIS between two groups at T1 and T2 (P ＞ 0.05).Both the MAP and HR had no statistical significance at T0 (P ＞ 0.05).MAP and HR in group B were significantly lower than those in group A from T1 to T4 (P ＜ 0.05).Compared with group A,patients in group B had significantly shorter extubation time (P ＜ 0.05),smaller dosages of sufentanyl and propofol (P ＜ 0.05),lower VAS scores at awake time 6 h and 12 h after surgery (P ＜ 0.05).Conclusions Brachial plexus and suprascapular nerve block combined with general anesthesia can offer better anesthesia status,reduce dosage of opioids and propofol,and can provide effective analgesia in shoulder arthroscopy.%目的 评价超声引导下臂丛加肩胛上神经阻滞联合全身麻醉在肩关节镜手术中的应用.方法 择期行肩关节镜手术的患者40例,ASA Ⅰ～Ⅱ级,年龄25 ～ 65岁,按随机数字表法分为A组(采用单纯全身麻醉)和B组(采用超声引导下臂丛加肩胛上神经阻滞复合全身麻醉),每组20例.在术前(T0)、手术开始5 min(T1)、手术开始30 min(T2)、手术结束时(T3)和拔除喉罩30 min时(T4)各时间点,观察并记录患者的平均动脉压(MAP)和心率(HR).记录T1和T2时间点的脑电双频指数(BIS)值.记录手术时间、术毕拔出喉罩时间、阿片类镇痛药物(舒芬太尼)用量、丙泊酚用量.记录在麻醉后监测治疗室(PACU)苏醒即刻、术后6、12、24 h各时间点的疼痛VAS评分.结果 两组间手术时间及T1、T2时间点的BIS值比较差异均无统计学意义(P＞0.05).两组间T0时间点的MAP和HR比较差异均无统计学意义(P＞0.05);B组T1 ～ T4时间点的MAP均显著低于A组(P＜0.05),HR均显著低于A组(P＜0.05).B组的拔喉罩时间显著短于A组(P＜0.05),舒芬太尼和丙泊酚用量显著少于A组(P＜0.05).B组苏醒即刻、术后6、12h的疼痛VAS评分均显著低于A组(P＜0.05),两组术后24 h的VAS评分比较差异无统计学意义(P＞0.05).结论 超声引导下臂丛加肩胛上神经阻滞联合全身麻醉用于肩关节镜手术,能够提供更加平稳的麻醉状态,更有利于手术操作,同时可减少术中麻醉药物和镇痛药物的用量,有利于术后镇痛.

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