摘要
目的分析超声引导下臂丛上干神经阻滞对肩关节镜手术患者围手术期的镇痛效果。方法前瞻性选取西安市第五医院2022年3月至2024年4月收治的102例进行肩关节镜手术的患者为研究对象,采用随机数字表法将研究对象分为对照组和观察组,每组51例。对照组给予超声引导下肌间沟臂丛神经阻滞,观察组给予超声引导下臂丛上干神经阻滞。比较分析两组患者切皮时(T_(0))、手术开始后5 min(T_(1))及手术结束时(T_(2))的血流动力学水平[平均动脉压(MAP)、心率(HR)]。比较分析两组患者不同时间点的疼痛程度[视觉模拟评分法(VAS)评分]、阻滞情况、术后镇痛情况以及术后不良反应发生情况。结果T_(1)时刻,两组患者的HR、MAP水平均低于T_(0)、T_(2)时刻,差异有统计学意义(P<0.05);T_(0)、T_(1)、T_(2)时刻,两组患者的HR、MAP水平比较差异均无统计学意义(P>0.05)。与苏醒即刻比较,两组患者术后1、6、24 h静息状态下的VAS评分均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者的运动阻滞时间、感觉阻滞时间均短于对照组,膈肌增厚分数高于对照组,单侧膈肌麻痹发生率、补救镇痛率、术后48 h的舒芬太尼用量均低于对照组,首次按压镇痛泵时间晚于对照组,差异均有统计学意义(P<0.05)。两组患者术后不良反应总发生率比较差异无统计学意义(P>0.05)。结论超声引导下臂丛上干神经阻滞可减轻肩关节镜手术患者围手术期的疼痛程度,降低单侧膈肌麻痹发生率,阻滞效果确切且安全性较好。
Objective To analyze the perioperative analgesia effect of ultrasound-guided superior brachial plexus trunk nerve block in patients undergoing arthroscopic shoulder surgery.Method A total of 102 patients who underwent arthroscopic shoulder surgery in Xi’an Fifth Hospital from March 2022 to April 2024 were prospectively selected as the research subjects.They were divided into the control group and the observation group by the random number table method,with 51 cases in each group.The control group was given ultrasound-guided intermuscular groove brachial plexus nerve block,while the observation group was given ultrasound-guided superior brachial plexus trunk nerve block.The hemodynamic levels(MAP,HR)in the two groups at the time of skin incision(T_(0)),5 minutes after the surgery(T_(1)),and at the end of the surgery(T_(2))were compared and analyzed.The pain degree(VAS score)at different time points,block condition,postoperative analgesia condition and the occurrence of postoperative adverse reactions in the two groups were compared and analyzed.Result At T_(1),the HR and MAP in two groups were lower than those at T_(0) and T_(2),and the difference was statistically signifi cant(P<0.05).At T_(0),T_(1),T_(2),there were no statistically signifi cant differences in HR and MAP between the two groups(P>0.05).Compared with the immediate awakening,the VAS scores in the two groups at 1,6,24 h at rest after the surgery were all increased,but the observation group was lower than the control group,and the differences were statistically signifi cant(P<0.05).The motor block time and sensory block time in the observation group were shorter than those in the control group,and the diaphragm thickening fraction was higher than that in the control group,and the incidence of unilateral diaphragmatic paralysis,the rescue analgesia rate,the sufentanil dosage 48 h after surgery were all lower than those in the control group,and the time of the fi rst compression of the analgesic pump was later than that in the control group,and the differences were all statistically signifi cant(P<0.05).There was no statistically signifi cant difference in the total incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided superior brachial plexus trunk nerve block can alleviate the perioperative pain degree of patients undergoing arthroscopic shoulder surgery,and reduce the incidence of unilateral diaphragmatic paralysis,with a defi nite block effect and good safety.
作者
贠永奇
吴永康
朱崇军
吴涛
Yun Yongqi;Wu Yongkang;Zhu Chongjun;Wu Tao(Department of Anesthesiology,Xi’an Fifth Hospital,Xi’an Shaanxi 710003,China;Department of Anesthesiology,Xi’an Ninth Hospital,Xi’an Shaanxi 710054,China)
出处
《中国医刊》
2026年第2期176-180,共5页
Chinese Journal of Medicine
基金
陕西省重点研发计划(2022SF-206)。
关键词
臂丛上干神经阻滞
肌间沟臂丛神经阻滞
肩关节镜手术
围手术期
镇痛
Superior brachial plexus trunk nerve block
Intermuscular groove brachial plexus nerve block
Arthroscopic shoulder surgery
Perioperative
Analgesia
