超声引导下DSN阻滞复合全身麻醉在肩胛骨骨折患者中的疗效与安全性分析  

Efficacy and Safety Analysis of DSN Block Combined with General Anesthesia Under Ultrasound Guidance in Scapula Fracture Patients

作　　者：李世英[1] 柴彬 邵忠新[1] LI Shiying;CHAI Bin;SHAO Zhongxin(Zhongshan Hospital Affiliated to Xiamen University, Fujian Xiamen 361001, China)

机构地区：[1]厦门大学附属中山医院,福建厦门361001

出　　处：《河北医学》2022年第6期964-968,共5页Hebei Medicine

基　　金：福建医学科技青年培育项目,(编号:18FBQN2018064)。

摘　　要：目的:探讨超声引导下肩胛背神经(DSN)阻滞联合全身麻醉在肩胛骨骨折手术患者术后镇痛的应用效果。方法:选择我院2018年3月至2021年10月收治的拟行手术治疗的152例肩胛骨骨折患者,随机数字表法将患者分为对照组和观察组两组,各76例。对照组患者于全身麻醉下行肩胛骨内固定手术,观察组则采用超声引导下DSN阻滞联合全身麻醉。比较两组手术时间、苏醒时间、血管活性药使用率、术中瑞芬太尼使用量,术后镇痛补救次数、术后开始康复锻炼时间、疼痛程度、肩关节活动度和并发症差异。结果:观察组术后苏醒时间、术中瑞芬太尼用量、术后镇痛补救次数、术后舒芬太尼用量、术后开始康复锻炼时间均低于对照组(P<0.05)。两组术后VAS评分均逐渐降低(P<0.05),肩关节被动前屈、后伸、内旋、外旋活动度均逐渐增加(P<0.05),观察组术后4h(T0)、8h(T1)、16h(T2)、24h(T3)、48h(T4)VAS评分均低于对照组(P<0.05),观察组T3、术后36h(M0)、T4、术后72h(M1)肩关节被动前屈、后伸、内旋、外旋活动度均大于对照组(P<0.05)。两组并发症比较差异无统计学意义(P>0.05)。结论:超声引导下DSN阻滞联合全身麻醉可减轻肩胛骨骨折患者术后疼痛程度,缩短术后肩关节康复锻炼开始时间,增加肩关节被动活动度,且安全可靠。Objective:To investigate the effect of ultrasound-guided scapular dorsal nerve(DSN)block combined with general anesthesia on postoperative analgesia of scapular fracture.Methods:A total of 152 patients with scapular fracture who were admitted to our hospital from March 2018 to October 2021 for surgical treatment were selected.The patients were divided into control group and observation group by random number table method,with 76 cases in each group.The control group was treated with scapular internal fixation under general anesthesia,while the observation group was treated with DSN block combined with general anesthesia under ultrasound guidance.The differences of operation time,recovery time,utilization rate of vasoactive drugs,amount of remifentanil used during operation,postoperative analgesic remedy times,postoperative rehabilitation exercise time,pain degree,range of motion of shoulder joint and complications were compared between the two groups.Results:The time of postoperative awakening,the amount of remifentanil,the number of postoperative analgesia,the amount of sufentanil and the time of postoperative rehabilitation exercise in the observation group were all lower than those in the control group(P<0.05).VAS scores in both groups decreased gradually(P<0.05),and passive flexion,extension,internal rotation and external rotation of shoulder joint increased gradually(P<0.05).VAS scores of the observation group at 4h(T0),8h(T1),16 h(T2),24h(T3)and 48h(T4)were lower than those of the control group(P<0.05).The activity of passive flexion,extension,internal rotation and external rotation in the observation group was greater than that in the control group at T3,36h(M0),T4 and 72h(M1)postoperatively(P<0.05).There was no significant difference in complications between the two groups(P>0.05).Conclusion:DSN block combined with general anesthesia under ultrasound guidance can reduce postoperative pain degree of scapular fracture patients,shorten the start time of postoperative shoulder rehabilitation exercise,and incr

关 键 词：肩胛背神经 全身麻醉 局部神经阻滞 肩胛骨骨折 术后镇痛 

分 类 号：R68[医药卫生—骨科学]