臂丛上干阻滞在老年肩关节镜手术中的应用  

作　　者：应海峰 曹东航[1] 黄珍鸯 

机构地区：[1]浙江省台州医院,317000

出　　处：《浙江临床医学》2023年第5期742-743,749,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨臂丛上干阻滞(ST)在老年患者肩关节镜手术中的应用效果。方法选取肩关节镜手术老年患者100例,随机分为ST组(50例)和ISB组(50例),比较阻滞前(T0)、阻滞后30 min(T1)、3 h(T2)膈肌移动度、麻痹程度、握力;阻滞后6 h(T3)、12 h(T4)、24 h(T5)握力、疼痛视觉模拟评分法(VAS);拔管时间、阻滞时间、术后镇痛药物用量。结果T2时ST组膈肌移动度大于ISB组(P<0.05),T1、T2时ST组膈肌麻痹程度轻于ISB组(P<0.05)、握力值大于ISB组(P<0.05);T3、T4、T5 ISB组与ST组握力差异无统计学意义(P>0.05),且两组VAS、拔管时间、运动及感觉阻滞持续时间、术后48 h内镇痛药物用量差异无统计学意义(P>0.05)。结论老年患者肩关节镜手术中,ST不仅能提供与ISB类似的良好镇痛,还可以降低膈肌麻痹的风险,且阻滞侧上肢更多的握力得到保留,该方法能提高老年肩关节镜手术围术期安全性与舒适度。Objective To investigate the effect of upper brachial plexus block(ST)in elderly patients undergoing shoulder arthroscopic surgery.Methods A total of 100 elderly patients with shoulder arthroscopic surgery were randomly selected and divided into the ST group(n=50)and the ISB group(n=50).The degree of septal muscle movement,paralysis and grip strength were compared before(T0),30 min(T1)and 3 h(T2)after the block.Grip strength at 6 h(T3),12 h(T4),24 h(T5)after block,and postoperative pain score(VAS)were compared.Extubation time,block time,postoperative analgesic dosage.Results At T2,the diaphragm mobility of ST group was greater than that of ISB group,with statistical significance(P<0.05).At T1 and T2,the diaphragm paralysis of ST group was less severe than that of ISB group(P<0.05),and the grip strength of ST group was greater than that of ISB group,with statistical significance(P<0.05).There was no significant difference in grip strength between T3,T4,T5 ISB group and ST group(P>0.05),and there was no statistically significant difference between the two groups in VAS,extubation time,duration of motor and sensory block,and analgesic drug dosage within 48 hours after surgery(P>0.05).Conclusion In elderly patients undergoing shoulder arthroscopic surgery,ST can not only provide good analgesia similar to ISB,but also reduce the risk of diaphragmatic paralysis,and more grip strength of the blocked upper limb can be preserved.This method can greatly improve the perioperative safety and comfort of shoulder arthroscopic surgery in elderly patients.

关 键 词：肩关节镜 臂丛上干 膈肌移动度 

分 类 号：R614[医药卫生—麻醉学]