全身麻醉复合臂丛神经阻滞提高肩关节镜术的麻醉质量  

General anesthesia combined with brachial plexus nerve block enhances the anesthesia quality in arthroscopic shoulder surgery

作　　者：李露[1] 李秋军[1] 周海滨[1] 杨庆国[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《国际麻醉学与复苏杂志》2013年第3期230-233,252,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨臂丛神经阻滞复合全身麻醉在肩关节镜术中的应用。方法择期在侧卧位下行肩关节镜手术的患者44例，美国麻醉医师协会（ASA）分级I或Ⅱ级，年龄35岁-65岁，体重50妇～90kg，按随机数字表法随机分为A、B两组（每组22例），均行静吸复合全身麻醉，B组全身麻醉前在超声引导下用0．2％罗哌卡因20ml行肌间沟神经阻滞。记录患者入室、切皮前、切皮、术中30、60、90min时、拔管后30min时的心率（HR）、有创收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）；术中舒芬太尼、罗库溴铵、艾司洛尔、硝酸异山梨酯的应用情况；手术前后的动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）；呼吸恢复时间、拔管时间、苏醒时间以及恢复阶段的疼痛视觉模拟评分（visualanalogscale，VAS）、镇痛药应用情况及并发症。结果A组和B组患者切皮时HR、MAP、七氟醚和舒芬太尼用量分别为（68±11）／min和（63±7）次／min、（86±15）mmHg和（69±10）mmHg（1mmHg=0．133kPa）、（1．28±0．21）最低肺泡有效浓度（millimumalveolarconcentration，MAC）和（1．08±0．20）MAC、（0．54±0．08）μg／kg和（0．34±0．06）μg／kg（P〈0．001）。A组和B组需要血管活性药物的例数、拔管时间、术后PaCO：分别为12例和2例、（13±10）min和（7±4）min、（44±3）mmHg和（42±3）mmHg（P〈0．05）。A组和B组在恢复阶段的疼痛VAS分别为（4±2）和（0±2）（P〈0．001）。两组间相关并发症的差异无统计学意义（P〉0．05）。结论臂丛神经阻滞复合全身麻醉能提高肩关节术中的麻醉质量，减少术中血压波动、麻醉性镇痛药和短效降压药的应用，缩短拔管时间，有短时术后镇痛效果，无严重并发症。Objective To evaluate the efficacy of anesthesia with general anesthesia combined with brachial plexus block in shoulder arthroscopy. Methods Forty-four patients （ASA I or 11 , aged 35 y-65 y, undergoing shoulder arthroscopy） were randomized into group A and B （n=22, each）. While both groups having received inhalation-intravenous general anesthesia （GA）, group B also received ultrasound-guided interscalene braehial plexus block with 0.2% ropivacaine 20 ml before GA. The HR, SBP, DBP and MAP at entering operation room, before skin incision, at skin incision, 30, 60, 90 min after skin incision, and 30 min after tracheal extubation,the use of sufentanyl, roeuronium, isosorbide dinitrate and esmolol, and SaO2, PaO2 and PaCO2 before and after surgery, and the spontaneous respiration regaining time, tracheal extubation time and fully consciousness regaining time, and the visual analog scale （VAS） of pain, analgesics application and complications in the PACU were recorded. Results The HR and MAP at skin incision, and the minimum alveolar concentration （MAC） of sevoflurane and dosage per weight of sufentanyl in group A and B were （68±11） bpm and （63±7） bpm, （86±15） mm Hg and （69±10） mm Hg（1 mm Hg=0.133 kPa）, （1.28±0.21） MAC and （1.08±0.20） MAC, （0.54±0.08） I±g/kg and（0.34±0.06） /xg/kg , respectively（P〈0.001 ）. The cases that needed esmolol or isosorbide dinitrate, the post-operation PaCO2 and the tracheal extubation time in group A and B were 12 and 2 cases, （13：t：10） rain and （7±_4） min, （44±3） mm Hg and （42±3） mm Hg, respectively （P〈0.05）. The pain VAS of group A and B were （4±2） and （0±2）, respectively （P〈0.001）. There were no significant statistic differences between the two groups in relevant complications （P〉0.05）. Conclusions Braehial plexus block combined with general anesthesia enhances the anesthesia quality in shoulder arthroscopy,which not only reduces the fluctuation of blood pressure, de

关 键 词：肩关节镜术 臂丛神经阻滞 全身麻醉 麻醉质量 

分 类 号：R614[医药卫生—麻醉学]