超声引导下臂丛上干神经阻滞复合闭环靶控输注全身麻醉在肩关节镜中的应用效果  

Application effect of ultrasound-guided superior brachial plexus block combined with closed-loop target-controlled infusion general anesthesia in shoulder arthroscopy

作　　者：张永明[1] 谌天奇 尹杏杏 张娇[1] 宋海波[1] ZHANG Yong-ming;SHEN Tianqi;YIN Xing-xing(Department of Anesthesiology,No.984 Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army,Beijing 100094,China)

机构地区：[1]中国人民解放军联勤保障部队第九八四医院麻醉科,100094

出　　处：《中国现代药物应用》2022年第21期27-30,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探讨超声引导下臂丛上干神经阻滞复合闭环靶控输注全身麻醉在肩关节镜中的应用效果。方法60例军事训练肩袖损伤行肩关节镜手术的患者,采用随机数字表法将患者分为观察组及对照组,每组30例。观察组行超声引导下臂丛上干神经阻滞复合闭环靶控输注全身麻醉,对照组行单纯闭环靶控输注全身麻醉。比较两组不同时间点[术前(T0)、手术开始10 min(T1)、手术开始30 min(T2)、手术结束时(T3)、拔管后1 min时(T4)]的心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)水平,麻醉药物(丙泊酚、瑞芬太尼)用量,不良反应发生情况。结果两组患者T0、T2、T3时的HR、MAP、BIS水平比较,差异无统计学意义(P>0.05);观察组T1时的HR、MAP、BIS水平分别为(65.3±4.1)次/min、(85.4±3.7)mm Hg(1 mm Hg=0.133 kPa)、(52.5±2.3),均低于对照组的(70.5±6.2)次/min、(91.3±4.2)mm Hg、(60.2±3.7);观察组T4时的HR、MAP、BIS水平分别为(64.7±3.2)次/min、(86.4±3.8)mm Hg、(53.6±2.4),均低于对照组的(71.3±5.8)次/min、(92.7±4.3)mm Hg、(61.0±3.8);差异具有统计学意义(P<0.05)。观察组患者的丙泊酚、瑞芬太尼用量均少于对照组,差异具有统计学意义(P<0.05)。观察组患者的不良反应发生率6.67%低于对照组的20.00%,但差异无统计学意义(P>0.05)。结论超声引导下臂丛上干神经阻滞复合闭环靶控输注全身麻醉在肩关节镜中的应用效果显著,由于前期手术部位预先镇痛,使闭环静脉全身麻醉过程平稳,镇静、镇痛药物减少,全身麻醉并发症减少。Objective To discuss the application effect of ultrasound-guided superior brachial plexus block combined with closed-loop target-controlled infusion general anesthesia in shoulder arthroscopy.Methods A total of 60 patients with rotator cuff injury in military training who underwent shoulder arthroscopy were divided into observation group and control group by random numerical table,with 30 cases in each group.The observation group received ultrasound-guided superior brachial plexus block combined with closed-loop target-controlled infusion general anesthesia,while the control group received general anesthesia with closed-loop target-controlled infusion alone.Both groups were compared in terms of heart rate(HR),mean arterial pressure(MAP)and bispectral index(BIS)at different time points[before surgery(T0),10 min after surgery(T1),30 min after surgery(T2),at the end of surgery(T3),and 1 min after extubation(T4)],anesthetic drugs(propofol,remifentanil)dosage,and occurrence of adverse reactions.Results At T0,T2 and T3,there was no statistically significant difference in HR,MAP and BIS levels between the two groups(P>0.05).At T1,the HR,MAP,and BIS levels in the observation group were(65.3±4.1)times/min,(85.4±3.7)mm Hg(1 mm Hg=0.133 kPa),and(52.5±2.3),which were lower than(70.5±6.2)times/min,(91.3±4.2)mm Hg,and(60.2±3.7)in the control group;at T4,the levels of HR,MAP and BIS in the observation group were(64.7±3.2)times/min,(86.4±3.8)mm Hg and(53.6±2.4),which were lower than(71.3±5.8)times/min,(92.7±4.3)mm Hg and(61.0±3.8)in the control group;the differences were all statistically significant(P<0.05).The dosages of propofol and remifentanil in the observation group were less than those in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 6.67%,which was lower than 20.00%in the control group,but the difference was not statistically significant(P>0.05).Conclusion Ultrasound-guided superior brachial plexus block combined wit

关 键 词：闭环靶控输注 肩关节镜 丙泊酚 瑞芬太尼 臂丛神经上干 脑电双频指数 

分 类 号：R614.2[医药卫生—麻醉学]