不同容量罗哌卡因肩胛舌骨肌下aSSNB用于全麻肩关节镜手术患者效果的比较  

Comparison of efficacy of different volume of ropivacaine for subomohyiod anterior suprascapular nerve block in patients undergoing arthroscopic shoulder surgery with general anesthesia

作　　者：尹加林[1] 尹海玲 浦江畔 王宏宇[1] 史宏伟[1] 鲍红光[1] 张勇[1] Yin Jialing;Yin Hailing;Pu Jiangpan;Wang Hongyu;Shi Hongwei;Bao Hongguang;Zhang Yong(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,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

出　　处：《中华麻醉学杂志》2022年第11期1293-1297,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:比较不同容量罗哌卡因肩胛舌骨肌下前路肩胛上神经阻滞(aSSNB)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135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3组(n=45):0.5%罗哌卡因容量分别为5 ml(L组)、10 ml(M组)和15 ml(H组)。麻醉诱导前,L组、M组和H组分别注入0.5%罗哌卡因5、10和15 ml行肩胛舌骨肌下aSSNB。注药后30 min时,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。记录术中瑞芬太尼用量和心血管事件发生情况。记录气管拔管时间、PACU停留时间和感觉阻滞持续时间。术后24 h时记录15项恢复质量量表评分和镇痛满意度评分。记录术后24 h内镇痛泵首次按压时间、镇痛泵有效按压次数、补救镇痛情况和恶心、呕吐、神经阻滞相关并发症的发生情况。结果:与L组比较,M组和H组膈肌麻痹发生率升高,膈肌麻痹程度加重,镇痛泵首次按压时间和感觉阻滞持续时间延长,镇痛泵有效按压次数减少,补救镇痛率降低,H组SpO_(2)降低幅度升高,术中瑞芬太尼用量减少(P<0.05);与M组比较,H组SpO_(2)降低幅度和膈肌麻痹发生率升高,膈肌麻痹程度加重,镇痛泵首次按压时间和感觉阻滞持续时间延长(P<0.05),术中瑞芬太尼用量、镇痛泵有效按压次数和补救镇痛率差异无统计学意义(P>0.05)。3组术中心血管事件发生率、镇痛满意度评分、呼吸困难发生率、气管拔管时间、PACU停留时间、术后15项恢复质量量表评分、恶心和呕吐发生率差异无统计学意义(P>0.05)。3组均未见Horner征和神经阻滞相关并发症的发生。结论:0.5%罗哌卡因10 ml肩胛舌骨肌下aSSNB用于全麻肩关节镜手术患者的效果最佳。Objective To compare the efficacy of different volume of ropivacaine for subomohyiod anterior suprascapular nerve block(aSSNB)in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods One hundred and thirty-five patients of either sex,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,scheduled for elective arthroscopic shoulder surgery,were divided into 3 groups(n=45 each)using a random number table method:0.5%ropivacaine 5 ml group(L group),10 ml group(M group),and 15 ml group(H group).Before induction,aSSNB was performed with 0.5%ropivacaine 5,10 and 15 ml in L,M and H groups,respectively.Diaphragmatic excursion,occurrence and degree of diaphragmatic paralysis,decrease in SpO_(2),dyspnea and Horner syndrome were recorded at 30 min after injection.The intraoperative consumption of remifentanil and cardiovascular events were recorded.The extubation time,length of post-anesthesia care unit stay,and duration of sensory block were recorded.Quality of Recovery-15 scale score and score for patient′s satisfaction with analgesia were recorded.The first pressing time of analgesic pump,effective pressing frequency of analgesic pump,requirement for rescue analgesia,nausea,vomiting and nerve block-related complications within 24 h after surgery were recorded.Results Compared with group L,the incidence of diaphragmatic paralysis was significantly increased,the degree of diaphragmatic paralysis was aggravated,the first pressing time of analgesic pump and duration of sensory block were prolonged,the effective pressing times of analgesic pump was reduced,and the requirement for rescue analgesia was decreased in M and H groups,and the decrease in SpO_(2) was significantly increased,and the introperative consumption of remifentanil was decreased in group H(P<0.05).Compared with group M,the decrease in SpO_(2) and incidence of diaphragmatic paralysis were significantly increased,the degree of diaphragmatic paralysis

关 键 词：神经传导阻滞 肩胛上神经 酰胺类 关节镜检查 肩关节 

分 类 号：R614.2[医药卫生—麻醉学]