静脉注射地塞米松联合颈神经根阻滞在肩关节镜手术围术期的应用  

Intravenous dexamethasone combined with ultrasound-guided selective cervical nerve root block for patients undergoing arthroscopic surgery in perioperative period

作　　者：周玉弟[1] 汤洋[1] 崔耀梅[1] 田伟千[1] 张艳华[1] ZHOU Yudi;TANG Yang;CUI Yaomei;TIAN Weiqian;ZHANG Yanhua(Department of Anesthesiology,Affiliated Hospital,Nanjing Medical University of TCM,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2018年第9期865-868,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨静脉注射地塞米松联合超声引导下选择性颈神经根阻滞对行肩关节镜手术镇痛效果的影响。方法选择择期行肩关节镜手术全麻患者60例,男35例,女25例,年龄33~75岁,BMI 19.5~28.1kg/m^2,ASAⅠ-Ⅲ级。随机分为两组,地塞米松组(A组)与对照组(B组),每组各30例。两组均在在超声引导下分别给予C_5、C_6神经根0.5%罗哌卡因各5ml;地塞米松组静脉给予地塞米松5mg(溶入共2ml生理盐水中),对照组静脉给予生理盐水2ml。记录两组神经阻滞起效时间;记录术后4、12、24hVAS评分;记录术后24h曲马多使用量;记录患者满意率;记录不良反应的发生情况。结果 A组起效时间明快于B组[(4.58±0.57)min vs(8.14±2.56)min,P<0.05];A组术后24h的VAS评分明显低于B组[(1.8.±0.7)分vs(3.5±1.3)分,(P<0.05)];与B组比较,A组术后24h曲马多用量明显减少[(36.5±24.9)mg vs(102.5±43.5)mg,(P<0.05)];A组满意率明显高于B组(87%vs 63%,P<0.05);两组间不良反应的发生情况差异无统计学意义。结论静脉注射5mg地塞米松明显延长了颈神经根阻滞肩关节镜手术患者镇痛时间,患者满意度高。Objective To investigate intravenous dexamethasone combined with ultrasoundguided selective cervical nerve root block on postoperative analgesia in patients underwent arthroscopic surgery.Methods Sixty patients,35 males and 25 females,aged 33-75 years,BMI 19.5-28.1 kg/m2,ASA physical status Ⅰ-Ⅲ,scheduled for arthroscopic surgery were randomly divided into two groups.Both in group A and group B,C5 and C6 nerve roots were given 0.5% ropivacaine 5 ml respectively;In the dexamethasone group,2 ml of dexamethasone 5 mg 1 ml＋normal saline 1 ml was intravenously administered,and the control group was intravenously administered normal saline 2 ml.The onset time of analgesia were recorded;the VAS score score were recorded at 4,12 and 24 hafter surgery;Cumulative tramadol consumption,the patients＇ satisfaction rate and adverse effects between the two groups were recorded.Results The onset time of group A was significantly faster than that of group B,[（4.58± 0.57）min vs（8.14 ± 2.56）min,P〈0.05].The VAS scores in group A was significantly lower than that in group B at 24 hours after surgery[（1.8±0.7）scores vs（3.5±1.3）scores,P〈0.05];Compared with group B,group A used less tramadol 24 hafter surgery,there was a significant difference between them[（36.5 ± 24.9）mg vs（102.5 ± 43.5）mg,P〈0.05].The satisfaction rate of group A was 87% and that of group B was 63%,the difference was significantly（P〈0.05）.The side effects were similar.Conclusion In arthroscopic surgery,intravenous injection of 5 mg dexamethasone can significantly prolong the analgesic time of patients with selective cervical nerve root block and with higher satisfaction.

关 键 词：颈神经根阻滞 地塞米松 肩关节镜手术 超声引导 

分 类 号：R614[医药卫生—麻醉学]