灌注流速对肩关节镜术后患者的康复效果研究  

Effect study of perfusion flow on postoperative rehabilitation of patients undergoing shoulder arthroscopy

作　　者：黄晓虹[1] 刘佳[1] 庄澄宇[1] 王晓宁[1] Huang Xiaohong;Liu Jia;Zhuang Chengyu;Wang Xiaoning(Operating Room,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院手术室,200025

出　　处：《中华肩肘外科电子杂志》2021年第3期236-243,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：上海市临床重点专科建设项目中西医结合骨关节病科(SHSLCZDZK04802)。

摘　　要：目的探讨灌注流速对肩关节镜术的手术时间,患者肢体肿胀、疼痛和肩关节功能康复的影响。方法将2020年6月至2020年9月在我院行肩关节镜下肩袖损伤修补手术患者92例。根据灌注流速不同,将患者随机分为0.6 L/min、0.8 L/min和1.0 L/min 3组,记录患者的基本资料、手术时间、灌注液总量及留存量,手术前后的颈围、胸围、臂围和三角肌周径的变化,患者术前、术后3个月、术后6个月的视觉模拟评分(visual analogue scale,VAS)及美国肩肘外科医师协会肩关节功能评分(rating scale of the American shoulder and elbow surgeons,ASES)。结果不同灌注流速对手术时间、灌注液体的总量及留存量、患者的肢体肿胀程度及疼痛缓解程度的差异均无统计学差异(P>0.05)。不同灌注流速对患者的肩关节功能康复效果在术后3个月时的差异无统计学意义(Z=4.439,P>0.05),但在术后6个月时差异有统计学意义(Z=6.176,P<0.05),0.6 L/min灌注流速的患者肩关节功能康复效果在术后6个月时优于1.0 L/min灌注流速的患者。结论在肩关节镜手术中采用较低的灌注流速(0.6 L/min),能保证手术操作不受影响,且提示患者远期功能康复效果更显著。Background Arthroscopic shoulder surgery is an increasingly mature minimally invasive diagnosis and treatment technology in treating rotator cuff injury.However,the accumulation of perfusion fluid in the joint cavity during the operation may result in limb swelling,postoperative pain,airway edema,stenosis or obstruction caused by upper airway compression,and even extend decannulation time pneumothorax and electrolyte disturbance.Therefore,selecting appropriate perfusion pressure and flow rate,controlling the total amount and retention of a perfusion fluid,ensuring intraoperative safety,optimizing the pain experience of patients,and promoting the functional rehabilitation of shoulder joint have become concerns for this type of surgery.Low perfusion pressure is considered to help reduce the accumulation of perfusion fluid.However,it is still unknown whether the perfusion flow rate will affect the operation process and interfere with the rehabilitation effect of patients under the premise of controlling the perfusion pressure.Objective To explore the application effect of perfusion flow on shoulder surgical operations,limb swelling,pain,and rehabilitation of patients undergoing shoulder arthroscopy.Methods From June 2020 to September 2020,92 patients who underwent shoulder arthroscopic rotator cuff repair in our hospital were randomly divided into three groups.The irrigation flow was 0.6 L/min,0.8 L/min,and 1.0 L/min,respectively.The demographic data,operation time,total amount and retention of irrigation fluid,and the changes of neck circumference,chest circumference,arm circumference,and deltoid circumference before and after operation were recorded.The preoperative,3-month postoperative,6-month postoperative VAS scores,and ASES scores were tested as well.Results There was no significant difference in operation time,total amount and retention of irrigation fluid,limb swelling degree,or pain relief degree of patients with different perfusion flows(P>0.05).There was no significant difference in the effect of diverse

关 键 词：肩关节镜 灌注液外渗 灌注流速 肿胀 

分 类 号：R687.4[医药卫生—骨科学] R493[医药卫生—外科学]