连续颈椎旁阻滞在肩关节手术麻醉的应用  

Continuous cervical paravertebral block for analgesia after shoulder surgery

作　　者：张伟[1] 胡焱[1] 刘雪冰[1] 朱丰[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《北京医学》2015年第3期253-255,共3页Beijing Medical Journal

摘　　要：目的评价连续颈椎旁阻滞在肩关节手术麻醉的应用及术后镇痛的有效性和安全性。方法将40例肩袖损伤拟行肩关节镜手术的患者随机分为神经刺激器组(S组)和超声联合神经刺激器组(U组),每组20例。采用改良颈椎旁阻滞入路进行穿刺和留置导管,分别于离开恢复室及术后4、24、48 h观察静息和运动(肩关节外展45°)时的视觉模拟评分(VAS)、前臂肌力、不良反应、辅助镇痛药用量等指标。结果 S组和U组的平均操作时间为(90.2±45.7)s和(57.5±28.1)s,差异有统计学意义(P=0.01);平均试探次数分别为(4.0±1.7)次和(2.7±1.2)次,差异有统计学意义(P=0.01)。2组患者术后4、24、48 h的静息和运动VAS评分、前臂(屈腕、屈指、屈肘)肌力等比较,差异无统计学意义(P>0.05)。2组患者均无严重不良反应。结论改良入路颈椎旁阻滞能安全有效地应用于肩关节术后镇痛,超声联合神经刺激器引导能提高穿刺的有效性,缩短操作时间。Objective To investigate the effect and safety of continuous cervical paravertebral block（CCPVB） for shoulder surgery and the two methods in which stimulator guided or ultrasound guided combined with stimulator were compared. Methods Forty patients scheduled for shoulder surgery were randomly assigned to group S or group U, 20 pa-tients in each group. Modified method for CCPVB（introduced by Boezaart） was utilized in group S, blocks were performed guided by stimulator. In group U, blocks were performed guided by ultrasound combined with stimulator. By the time pa-tients left post anesthesia recovery room and on postoperative 4,24,48 h, the VAS during the rest and movement were not-ed. The muscle strength of forearm, side effects, complementary pain killers were also noted on the above time points. Results The perform duration time in group S and group U was（90.2±45.7）s and（57.5±28.1）s, P = 0.01. There was no significant difference between the two groups on all time points considering VAS, muscle strength（ P 0.05）. There was no severe side effects in both groups（P 0.05）. Conclusion The results of this study indicate that modified CCPVB can be used safely and effectively for analgesia for shoulder surgery. Ultrasound guided combined with stimultor can improve effi-ciency and shorten the block performance time.

关 键 词：超声引导 颈椎旁阻滞 肩关节手术 

分 类 号：R614[医药卫生—麻醉学]