连续肌间沟臂丛神经阻滞对关节镜肩袖修复术患者围手术期管理的影响  

Effects of continuous interscalene brachial plexus block plus general anesthesia versus general anesthesia alone on perioperative management of arthroscopic rotator cuff repair surgery

作　　者：魏越[1] 郭向阳[1] 杨璐[1] 戎玉兰[1] 许川雅[1] 李民[1] 

机构地区：[1]北京大学第三医院麻醉科,100191

出　　处：《中华医学杂志》2012年第33期2327-2330,共4页National Medical Journal of China

摘　　要：目的观察连续肌间沟臂丛神经阻滞（CISB）复合全身麻醉（GA）对行肩关节镜手术的患者术中血流动力学控制、全身麻醉用药量、术野出血情况、术后镇痛、并发症等方面的影响。方法经北京大学第三医院伦理委员会批准，选择2010年11月至2011年10月于北京大学第三医院行择期单侧肩关节镜下肩袖修复术的患者60例。使用随机数字表将患者随机分为肌间沟臂丛神经阻滞复合全身麻醉组（ISB±GA组）和全身麻醉组（GA组）。ISB±GA组患者首先接受ISB，两组患者均接受GA，术中实施控制性降压，维持外耳道水平平均动脉压（MAP）60—65mmHg（1mmHg=0．133kPa），术后ISB±GA组采用CISB镇痛，GA组使用静脉患者自控镇痛（PCIA）。结果两组均能提供较好的手术视野，术野评分差异无统计学意义。维持期间ISB±GA组较GA组瑞芬太尼用量低[（0．04±0．03）vs（0．14±0．03）μg·kg^-1·min^-1，P〈0．01]，七氟烷吸入浓度亦低（1．80％±0．5％比2．1％±10．5％，P〈0．05）。术中两组患者均能维持理想的目标血压，组间比较各时点MAP和心率差异无统计学意义；手术结束后各时点MAP和心率ISB±GA组均低于GA组（P〈0．05）。术后ISB±GA组疼痛评分均低于GA组（P〈0．01），患者满意度高于GA组[8（6～10）比7（5—10），P〈0．01]。结论与单纯GA比较，ISB复合GA能更好控制术中血压，减少术中全麻药用量，使患者苏醒更快，术后镇痛效果更好，并发症更少，患者满意度更高。在肩关节镜手术时采用ISB复合GA是更好的选择。Objective To compare continuous interscalene brachial plexus block （CISB） in the patients undergoing rotator cuff repair surgery. Methods A total of 60 patients undergoing rotator cuff repair surgery were randomly assigned to either ISB plus GA group （ISB ± GA group） or GA group. Preoperatively, an interscalene catheter was placed in the ISB ± GA group patients. Both groups received general anesthesia. The intraoperative mean arterial pressure （MAP） at the level of external acoustic meatus was maintained at a target of 60 - 65 mm Hg with a continuous infusion of remifentanil. Postoperatively, the patients in the ISB ± GA and GA groups received CISB and patient controlled intravenous analgesia （PCIA） respectively for 48 h. Results Surgical field conditions were similar in two groups（P = 1. 000）. Compared to the GA group, the consumption of remifentanil [ （ 0. 04 ± 0. 03 ） vs （ 0. 14 ± 0. 03 ） μg · kg^-1 · min^ -1, p 〈 0.01 ] and the inhalational concentration of sevoflurane（ 1.80% ± 0. 5% vs 2. 1% ± 0. 5%, P 〈 O. 05 ） were lower in the ISB ± GA group. Compared to the GA group, the values of MAP and heart rate （HR） were lower at all postoperative time-points in the ISB ＋ GA group （ P 〈 0. 05 ） . The postoperative measurements of numerical rating pain score （NRPS） were lower （P 〈 0. 01 ） and the level of patient satisfaction was greater in the ISB ＋ GA group [ 8 （ 6 - 10 ） vs 7 （ 5 - 10 ）, P 〈0. 01 ]. Conclusion In comparisons with GA alone for rotator cuff repair surgery, the combined uses of ISB and GA may achieve a better perioperative control of hemodynamic responses, a markedly reduced consumption of general anesthetics, a rapid recovery of consciousness from anesthesia, superior analgesia with fewer side effects and greater patient satisfaction.

关 键 词：臂丛神经阻滞 肩关节手术 控制性降压 

分 类 号：R614[医药卫生—麻醉学]