超声引导下前锯肌阻滞在肩关节中的应用效果及对瑞芬太尼剂量和术后镇痛的影响  

Effect of anterior serratus block in shoulder joint and on remifentanil dose and postoperative analgesia via ultrasound guidance

作　　者：张宏鑫 石小龙 杜宝媛 ZHANG Hong-xin;SHI Xiao-long;DU Bao-yuan(Department of Anesthesiology,Yellow River Sanmenxia Hospital(Affiliated Yellow River Hospital Of He'nan University of Science and Technology),Sanmenxia He'nan 472000,China;Department of Pediatrics,Yellow River Sanmenxia Hospital(Affiliated Yellow River Hospital Of He'nan University of Science and Technology),Sanmenxia He'nan 472000,China)

机构地区：[1]黄河三门峡医院(河南科技大学附属黄河医院)麻醉科,河南三门峡472000 [2]黄河三门峡医院(河南科技大学附属黄河医院)儿科,河南三门峡472000

出　　处：《临床和实验医学杂志》2020年第21期2325-2328,共4页Journal of Clinical and Experimental Medicine

基　　金：河南省医学科技攻关项目(编号:201304040)。

摘　　要：目的探究超声引导下前锯肌阻滞在肩关节中的应用效果及对瑞芬太尼剂量和术后镇痛的影响。方法前瞻性选取黄河三门峡医院2017年2月至2019年10月收治的80例肩关节镜下袖缝合手术患者,采用随机数字分组法分为实验组(n=41)与对照组(n=39)。对照组给予瑞芬太尼全麻处理,实验组在对照组的基础上加用超声引导下前锯肌阻滞处理。比较2组患者手术指标(瑞芬太尼使用量、术后拔管时间、麻醉恢复时间);比较2组患者手术前、手术后2周生活质量;比较2组患者手术前,手术后1 d、3 d、7 d疼痛程度;比较2组患者术后并发症。结果手术中,实验组瑞芬太尼使用量(532.32±127.12)μg明显低于对照组(621.98±123.22)μg,术后拔管时间(15.01±6.12)h、麻醉恢复时间(16.56±6.87)h明显短于对照组[(25.12±6.32)h、(26.56±6.89)h],差异具有统计学意义(P<0.05)。治疗2周后,实验组生活质量简表(SF-36)评分(90.52±6.41)分明显高于对照组(74.12±6.33)分,差异具有统计学意义(P<0.05)。实验组术后1 d、3 d、7 d疼痛评分[(7.23±6.12)分、(3.12±1.23)分、(1.12±0.12分)]显著低于对照组[(10.12±6.23)分、(5.12±1.33)分、(3.12±0.23)分],差异具有统计学意义(P<0.05)。2组患者术后,实验组不良反应发生率4.88%(2/41)明显低于对照组25.64%(10/39),差异具有统计学意义(P<0.05)。结论超声引导下前锯肌阻滞在肩关节手术中的应用效果较好,可以有效降低瑞芬太尼剂量,同时可以显著降低患者术后疼痛程度,提高患者生活质量,并且不会增加不良反应发生。Objective To explore the effect of ultrasound-guided anterior serratus block in shoulder joint and on the dose of remifentanil and postoperative analgesia.Methods Eighty patients with sleeve closure surgery via shoulder arthroscopy in our hospital from February 2017 to October 2019 were divided into the experimental group(n=41)and the control group(n=39)by random number table.The experimental group supplemented with ultrasound-guided anterior serratus block on the basis of the control group,while the control group received remifentanil for general anesthesia.The surgical indicators(remifentanil dosage,postoperative extubation time,anesthesia recovery time)between the two groups;the quality of life of before and 2 weeks after the operation;the pain levels before and 1,3,7 days after operation;the postoperative complications were between the two groups.Results During the operation,the remifentanil disage in the experimental group(532.32±127.12)μg was significantly lower than that in the control group(621.98±123.22)μg,and the postoperative extubation time(15.01±6.12)h and the anesthesia recovery time(16.56±6.87)h were significantly shorter than the control group[(25.12±6.32)h,(26.56±6.89)h](P<0.05).After 2 weeks of treatment,the score of the MOS item short from health survey(SF-36)in the experimental group(90.52±6.41)points were significantly higher than those in the control group(74.12±6.33)points(P<0.05).The pain scores of the experimental group at 1,3,and 7 days after operation[(7.23±6.12)points,(3.12±1.23)points,(1.12±0.12)points]were significantly lower than those of the control group[(10.12±6.23)points,(5.12±1.33)points,(3.12±0.23)points](P<0.05).After surgery,the incidence of adverse reactions in the experimental group 4.88%(2/41)was significantly lower than that in the control group 25.64%(10/39),P<0.05].Conclusion The Ultrasound-guided anterior serratus block has good effect in shoulder surgery,which can effectively reduce the dose of remifentanil,and the postoperative pain significantly,imp

关 键 词：超声引导下前锯肌阻滞 肩关节 瑞芬太尼 术后镇痛 应用效果 

分 类 号：R614[医药卫生—麻醉学]