肩胛舌骨肌下前路SSNB用于全麻肩关节镜手术患者的效果  

Efficacy of subomohyoid anterior suprascapular nerve block in patients undergoing arthroscopic shoulder surgery with general anesthesia

作　　者：尹海玲 张文文[1] 浦江畔 黄岚 蒋宇智[1] 鲍红光[1] 张勇[1] Yin Hailing;Zhang Wenwen;Pu Jiangpan;Huang Lan;Jiang Yuzhi;Bao Hongguang;Zhang Yong(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Anesthesiology,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉科,南京210006 [2]南京中医药大学附属医院麻醉科,南京210029

出　　处：《中华麻醉学杂志》2022年第1期29-33,共5页Chinese Journal of Anesthesiology

基　　金：南京市卫生科技发展专项资金项目 (YKK19081)。

摘　　要：目的评价肩胛舌骨肌下前路肩胛上神经阻滞(SSNB)用于全麻肩关节镜手术患者的效果。方法择期行肩关节镜手术患者60例,性别不限,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,BMI 18~30 kg/m^(2),采用随机数字表法分为2组(n=30):SSNB组(S组)和肌间沟臂丛神经阻滞(ISB)组(I组)。麻醉诱导前,I组在C_(5)-6神经根之间、S组在肩胛舌骨肌下的前路肩胛上神经周围分别注射0.375%盐酸罗哌卡因15 ml。注药后30 min,记录膈肌活动度,膈肌麻痹发生情况和程度、SpO_(2)降低幅度、呼吸困难和Horner征发生情况,C_(5)-T_(1)皮区感觉阻滞情况。记录术中瑞芬太尼用量。记录气管拔管时间、PACU停留时间。记录术后24 h 15项恢复质量量表(QoR-15)评分、镇痛满意度评分、镇痛泵有效按压次数、补救镇痛情况、恶心、呕吐及神经阻滞相关并发症发生情况。结果与I组比较,S组膈肌麻痹发生率降低,程度减轻,膈肌活动度升高,SpO_(2)降低幅度减小,Horner征和呼吸困难发生率明显降低,气管拔管时间缩短(P<0.05),C_(5)-T_(1)皮区感觉阻滞发生率、术中瑞芬太尼用量、镇痛泵有效按压次数、补救镇痛率、镇痛满意度评分、恶心发生率、PACU停留时间和QoR-15评分差异无统计学意义(P>0.05)。结论肩胛舌骨肌下前路SSNB用于全麻肩关节镜手术患者不仅围术期镇痛效果确切,还可降低膈神经麻痹发生风险。Objective To evaluate the efficacy of subomohyoid anterior suprascapular nerve block(SSNB)in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods Sixty patients of either sex,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective arthroscopic shoulder surgery,were divided into 2 groups(n=30 each)using a random number table method:SSNB group(S group)and interscalene brachial plexus block group(I group).Before induction,0.375%ropivacaine hydrochloride 15 ml was injected between C_(5)-C_(6) nerve roots in group I and around the anterior suprascapular nerve in group S under ultrasound guidance.Diaphragmatic excursion,occurrence and degree of diaphragmatic paralysis,decrease in SpO_(2),dyspnea,Horner syndrome and sensory block in the C_(5)-T_(1) dermatomes were assessed at 30 min after injection.The intraoperative consumption of remifentanil,extubation time,and length of post-anesthesia care unit stay were recorded.Quality of Recovery-15 score for patient′s satisfaction with analgesia,effective pressing frequency of analgesic pump,requirement for rescue analgesia,nausea and vomiting and nerve block-related complications within 24 h after surgery were recorded.Results Compared with group I,the incidence of diaphragmatic paralysis was significantly decreased,the degree of diaphragmatic paralysis was reduced,diaphragmatic excursion was increased,the amplitude of decrease in SpO_(2) was reduced,the incidence of dyspnea and Horner syndrome was decreased,extubation time was shortened(P<0.05),and no significant change was found in the incidence of sensory block in the C_(5)-T_(1) dermatomes,intraoperative consumption of remifentanil,effective pressing frequency of analgesic pump,requirement for rescue analgesia,score for patient′s satisfaction with analgesia,incidence of nausea and vomiting,length of post-anesthesia care unit stay,or Quality of Recovery-15 score in group S(P>0.05).Conclusions The subomoh

关 键 词：神经传导阻滞 臂丛 关节镜检查 肩关节 肩胛上神经 

分 类 号：R614[医药卫生—麻醉学]