超声引导下臂丛上干阻滞麻醉对全身麻醉肩关节手术患者苏醒质量及安全性探讨  

Quality of recovery and safety of ultrasound-guided superior trunk block in patients with shoulder joint surgery under general anesthesia

作　　者：殷臣竹 阴文超 于天雷 李曼 张兰[1] Yin Chenzhu;Yin Wenchao;Yu Tianlei;Li Man;Zhang Lan(Department of Anesthesiology,Sichuan Orthopaedic Hospital,Chengdu 610000,China)

机构地区：[1]四川省骨科医院麻醉科,成都610000

出　　处：《创伤外科杂志》2023年第3期210-215,共6页Journal of Traumatic Surgery

基　　金：四川省医学青年创新科研课题(Q19003)。

摘　　要：目的探讨超声引导下臂丛上干阻滞麻醉对全身麻醉肩关节手术患者苏醒质量及安全性。方法前瞻性研究2019年9月—2021年9月四川省骨科医院麻醉科收治的行择期肩关节手术患者52例,男性29例,女性23例;年龄40~77岁,平均58.8岁;体质量指数22.1~27.8kg/m^(2),平均24.4kg/m^(2);美国麻醉医师协会分级:Ⅰ级29例,Ⅱ级23例;跌倒伤23例,道路交通伤15例,高处坠落伤9例,其他伤5例;按照随机数字表法分为对照组及观察组,各26例。对照组行超声引导下肌间沟臂丛神经阻滞麻醉,观察组行超声引导下臂丛上干阻滞麻醉,待阻滞麻醉完毕后均行全身麻醉及控制性降压,于术后实施自控静脉镇痛。比较两组患者镇痛效果、血流动力学水平、苏醒质量及安全性,监测时点:切皮时(T0)、手术开始后15min(T1)、手术开始后30min(T2)、手术结束(T3)、术后1h(T4)、术后6h(T5)、术后12h(T6)、术后24h(T7)。结果于T4、T5、T6、T7时点,观察组疼痛数字分级法(numerical rating scale,NRS)低于对照组[(2.5±0.9)分vs.(3.1±1.0)分、(2.2±0.7)分vs.(2.7±0.9)分、(1.8±0.6)分vs.(2.3±0.9)分、(1.7±0.5)分vs.(2.2±0.8)分,P<0.05],观察组自控静脉镇痛使用次数(0.7±0.5)次与对照组(0.8±0.6)次比较,差异无统计学意义(P>0.05);与T0时点比较,两组患者T1、T2、T3时点平均静脉压、心率水平比较差异无统计学意义[(75.4±11.4)mmHg、(76.2±9.5)mmHg、(75.3±7.8)mmHg vs.(79.5±8.1)mmHg,(76.5±10.6)mmHg、(75.7±8.3)mmHg、(77.0±7.5)mmHg vs.(77.7±7.4)mmHg;(62.7±7.8)次/min、(63.2±7.5)次/min、(63.8±8.3)次/min vs.(65.3±6.3)mmHg,(63.1±8.0)次/min、(62.9±7.5)次/min、(63.1±7.5)次/min vs.(66.1±6.8)次/min](P>0.05),且两组患者同时点平均静脉压、心率水平比较,差异无统计学意义(P>0.05);观察组拔管时间、苏醒时间[(5.9±2.6)min、(18.5±5.5)min]与对照组[(6.1±2.6)min、(20.4±6.2)min]比较,差异无统计学意义(P>0.05);观察组声嘶、霍纳综合征�Objective To investigate the recovery quality and safety of ultrasound-guided superior trunk block in shoulder joint surgery patients under general anesthesia.Methods Totally 52 patients admitted to the Department of Anesthesiology of Sichuan Orthopaedic Hospital from Sep.2019 to Sep.2021 and received elective shoulder joint surgeries were prospectively enrolled,including 29 males and 23 females aged 40-77 years,mean 58.8 years.The body mass index was 22.1~27.8 kg/m^(2),24.4 kg/m^(2)on average.The American Society of Anesthesiologists classification revealed 29 cases of grade I and 23 grade II.There were 23 fall injuries,15 traffic accident injuries,9 falls from height and 5 others.Patients were randomly(random number table)divided into control group and observation group(n=26 for each).The control group was given ultrasound-guided interscalene brachial plexus block,while the observation group was given ultrasound-guided superior trunk block.Thereafter,general anesthesia and controlled hypotension were conducted,followed by intravenous patient-controlled analgesia postoperatively.The analgesic effect,hemodynamic level,recovery quality and safety were recorded at the time points of skin incision(T0),15 min from the start of surgery(T1),30 min from the start of surgery(T2),end of surgery(T3),postoperative 1h(T4),postoperative 6h(T5),postoperative 12h(T6),and postoperative 24 h(T7).Results At T4,T5,T6,T7(postoperatively),the pain numerical rating scale(NRS)of the observation group was significantly lower than that of the control group(2.5±0.9 vs.3.1±1.0,2.2±0.7 vs.2.7±0.9,1.8±0.6 vs.2.3±0.9,1.7±0.5 vs.2.2±0.8),all P<0.05.The frequency of intravenous patient-controlled analgesia showed no significant difference between observation(0.7±0.5)and control(0.8±0.6)groups(P>0.05).At T0-T4,the mean venous pressure(mmHg)were respectively 79.5±8.1,75.4±11.4,76.2±9.5,75.3±7.8 in control group and 77.7±7.4,76.5±10.6,75.7±8.3,77.0±7.5 in observation group,which showed no significant difference either between T0

关 键 词：肩关节手术 超声 全麻 上干阻滞麻醉 苏醒质量 

分 类 号：R614[医药卫生—麻醉学]