摘要
目的 比较超声引导下臂丛神经上干阻滞与肌间沟臂丛和神经阻滞在复合全身麻醉(以下简称全麻)肩关节镜手术中的应用效果。方法 选取2024年1—12月北京市第六医院和首都医科大学附属北京朝阳医院择期行肩关节镜手术的患者82例,将患者随机分为超声引导下臂丛神经上干阻滞复合全麻组(S组)和超声引导下肌间沟臂丛神经阻滞复合全麻组(I组),每组41例。两组均在全麻诱导前接受超声引导下神经阻滞,使用0.375%罗哌卡因10 ml。比较两组患者入室时(T0)、切皮时(T1)、手术开始后10 min(T2)和手术开始后30 min(T3)、拔除喉罩后10 min(T4)的血流动力学变化,术中丙泊酚和瑞芬太尼用量,阻滞前和实施后30 min阻滞侧及对侧膈肌活动度及膈肌麻痹发生情况,以及术后4 h、12 h、24 h的视觉模拟评分(visual analogue scale, VAS),前臂运动(屈肘、屈腕、屈指)功能状态量表(motor status scale, MBS)评分和并发症发生情况。结果 82例患者中男17例、女65例,年龄25~75岁,美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级为Ⅰ~Ⅱ级。两组患者一般资料、不同时点血流动力学指标、术中丙泊酚和瑞芬太尼用量的比较,差异均无统计学意义(P > 0.05)。与阻滞前相比,阻滞30 min后,两组患者阻滞侧平静呼吸位和最大呼吸位膈肌活动度较低、对侧膈肌活动度较高,差异均有统计学意义(P<0.05)。与S组相比,I组阻滞后阻滞侧的平静呼吸位和最大呼吸位膈肌活动度均较低,且膈肌麻痹发生率更高,差异均有统计学意义(P<0.05)。两组术后不同时点VAS评分、MBS评分和不良反应的比较,差异均无统计学意义(P > 0.05)。结论 在复合全麻肩关节镜手术中,超声引导下臂丛神经上干阻滞可达到与肌间沟臂丛神经阻滞相当的镇痛效果,且膈肌麻痹发生率更低。
Objective To compare the effects of ultrasound-guided superior trunk block and interscalene brachial plexus block in shoulder arthroscopy under combined general anesthesia.Methods A total of 82 patients who underwent arthroscopic surgery in Beijing Sixth Hospital and Beijing Chaoyang Hospital,Capital Medical University from January to December,2024 were selected,and were randomly divided into ultrasound-guided superior trunk block group(group S)and interscalene brachial plexus block group(group I),with 41 patients in each group.Both groups received ultrasound-guided nerve blocks with 10 ml of 0.375%ropivacaine before general anesthesia induction.The hemodynamic changes at the time of entering the room(T0),skin incision(T1),10 min after operation(T2),30 min after operation(T3)and 10 min after laryngeal mask removal(T4),the dosage of propofol and remifentanil during surgery,the diaphragmatic activity and the occurrence of diaphragmatic paralysis on the blocking side and the contralateral side before and 30 min after the block,as well as the visual analogue scale(VAS),motor status scale(MBS)of forearm movements(elbow flexion,wrist flexion and finger flexion),complications at 4 h,12 h and 24 h after surgery were compared between the two groups.Results Among the 82 patients,17 were males and 65 were females,aged from 25 to 75 years old.The American Society of Anesthesiologists(ASA)classified asⅠandⅡ.There were no significant differences in general data,hemodynamic indicators at different time points,and the dosage of propofol and remifentanil during surgery between the two groups(P>0.05).Compared with before block,the diaphragmatic activity in the rest breathing position,maximum breathing position was lower,the diaphragmatic activity in the opposite side was higher of the two groups after 30 min of block,with statistical significance(P<0.05).Compared with group S,the diaphragmatic activity at the rest breathing position and maximum breathing position of the blocked side in group I was both lower,and the incidence of diaphragmatic paralysis was higher,with statistical significance(P<0.05).There were no significant differences in VAS score,MBS score at different time points after surgery,and adverse reactions between the two groups(P>0.05).Conclusions For arthroscopic shoulder surgery under combined general anesthesia,ultrasound-guided superior trunk block can achieve the same analgesic effect as the interscalene brachial plexus block,and the incidence of diaphragmatic paralysis is lower.
作者
马云龙
田芳玲
马艳巍
温洪
Ma Yunlong;Tian Fangling;Ma Yanwei;Wen Hong(Department of Anesthesiology,Beijing Sixth Hospital,Beijing 100007,China)
出处
《北京医学》
2025年第9期761-765,共5页
Beijing Medical Journal
关键词
超声引导
臂丛神经上干阻滞
肌间沟臂丛神经阻滞
膈肌麻痹
全身麻醉
ultrasound-guided
superior trunk block
interscalene brachial plexus block
diaphragmatic paralysis
general anesthesia
