肩关节镜手术两种神经阻滞方式比较  

Comparison of two nerve block approaches in arthroscopic shoulder surgery

作　　者：张琳[1] 张燕[2] 潘侠[1] ZHANG Lin;ZHANG Yan;PAN Xia(Operating Room,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Anesthesia,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院麻醉科,湖北武汉430060 [2]武汉大学人民医院心内科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2022年第6期1016-1019,共4页Medical Journal of Wuhan University

基　　金：武汉大学人民医院湖北省重点实验室开放项目(编号:2021KFH017)。

摘　　要：目的:探讨肩胛上神经阻滞(SSNB)与肌间沟神经阻滞(ISB)在肩关节镜手术中的镇痛效果、麻醉药用量及安全性比较。方法:选取2019年1月至2020年1月期间60例行单侧肩关节镜择期手术患者,所有患者分为SSNB组和ISB组,每组30例。阻滞效果满意后行全麻手术,术中靶控输注丙泊酚及瑞芬太尼,记录用量;术后1 h、3 h以及1 d、3 d记录视觉模拟量表(VAS)疼痛评分,记录术后3 d内患者曲马多给药量;记录患者术前和术后1 d的肺活量;记录各组患者术后恶心呕吐(PONV)、Horner综合征、声音嘶哑、呼吸困难等术后并发症发生率;记录患者满意度。结果:SSNB组患者术后3 h和1 d VAS疼痛评分均低于ISB组(P<0.05);SSNB组术中丙泊酚和瑞芬太尼需要量均少于ISB组(P<0.05);两组术后3 d内镇痛药物需要量无显著差异(P>0.05);ISB组术后1 d肺活量相对于术前明显下降(P<0.05);SSNB组术前及术后1 d肺活量变化无显著差异(P>0.05);SSNB组声音嘶哑和呼吸困难发生率均明显低于ISB组(P<0.05);SSNB组患者满意度高于ISB组(P<0.05)。结论:SSNB能够为肩关节镜手术患者提供更有效的术中及术后镇痛效果,降低术中麻醉药物使用量,对肺活量影响小,患者满意度高。Objective:To investigate the analgesic effect,anesthetic dosage,and safety of suprascapular nerve block(SSNB)and interscalene nerve block(ISB)in shoulder arthroscopy.Methods:From Janu⁃ary 2019 to January 2020,68 patients who underwent elective unilateral shoulder arthroscopy surgery were selected.All patients were divided into SSNB group and ISB group,with 34 cases in each group.Before operation,20 mL 0.375%ropivacaine was used for SSNB and ISB.After the block effect was satisfactory,all patients received target⁃controlled infusion of propofol during the opera⁃tion.The visual analogue scale(VAS)pain scores were recorded at the end⁃points of 1 h,3 h,1 d,and 3 d after surgery,the amount of propofol and remifentanil used during the operation,and the amount of tramadol administered by the patients within 3 days after the operation were recorded.The vital capacity of patients before and one day after surgery was recorded.The incidence of postopera⁃tive complications such as nausea and vomiting(PONV),Horner syndromes,hoarseness,and dyspnea and satisfaction degree of patients were recorded after surgery.Results:The VAS pain scores in the SSNB group at 3 h and 1 d post⁃operation were lower than those in the ISB group(P<0.05),and there was no significant difference in the VAS pain scores at 1 h and 3 d post⁃operation between the two groups(P>0.05);In SSNB group,the intraoperative propofol and remifentanil requirements were less than those in the ISB group(P<0.05),but there was no significant difference in analgesic drug requirements between the two groups within 3 days(P>0.05).The vital capacity of the ISB group after 1 day was significantly lower than that before surgery(P<0.05),while no significant changes were found in the vital capacity of the SSNB group at 1 day post⁃operation(P>0.05).There was no significant difference in the incidence of PONV and Horner syndromes between the two groups(P>0.05);the incidence of hoarseness and dyspnea in SSNB group was significantly lower than that respectively in ISB

关 键 词：肩胛上神经阻滞 肌间沟神经阻滞 肩关节镜手术 术后镇痛 

分 类 号：R4[医药卫生—临床医学]