静脉全麻复合臂丛神经阻滞麻醉在肩部关节手术中的应用效果  

Application of intravenous general anesthesia combined with brachial plexus block anesthesia in shoulder joint surgery

作　　者：刘仑[1] 贺云云 江涛[2] LIU Lun;HE Yunyun;JIANG Tao(Department of Anesthesiology,Anhui University of Technology Affiliated Huainan Dongfang Hospital Group General Hospital,Huainan Anhui 232001,China;Department of Orthopedics,Anhui University of Technology Affiliated Huainan Dongfang Hospital Group General Hospital,Huainan Anhui 232001,China)

机构地区：[1]安徽理工大学附属淮南东方医院集团总医院麻醉科,安徽淮南232001 [2]安徽理工大学附属淮南东方医院集团总医院骨科,安徽淮南232001

出　　处：《新疆医科大学学报》2023年第6期786-790,共5页Journal of Xinjiang Medical University

基　　金：安徽省自然科学基金项目(2108085M32)。

摘　　要：目的 探究静脉全麻复合臂丛神经阻滞麻醉在肩部关节手术中的应用效果及对患者血清皮质醇(Cor)水平的影响。方法 选取安徽理工大学附属淮南东方医院集团总医院2020年9月至2022年9月收治的接受肩关节镜手术治疗的患者84例,随机分为试验组和对照组,每组各42例,对照组采用静脉全麻,试验组采用静脉全麻复合臂丛神经阻滞麻醉。比较两组患者术前(T1)、开始手术时(T2)、手术开始30 min(T3)、拔管后10 min(T4)的平均动脉压(MAP)、心率(HR)、血清皮质醇(Cor)水平,采用Likert 5级评分法评估术中视野清晰度,记录两组患者的手术时间、灌洗液用量和术后并发症。结果 试验组T2、T3、T4时点MAP均低于对照组(P<0.05);T2、T3、T4时点,试验组和对照组的MAP较T1时均降低(P<0.05);对照组自T1至T2、T3时点MAP逐渐降低,T4时点回升,各时间点比较差异均具有统计学意义(P<0.05)。T2、T3、T4时点,试验组和对照组的MAP较T1时点均降低(P<0.05)。试验组T2、T3、T4时点血清Cor水平均低于对照组(P<0.05);T2、T3、T4时点,试验组和对照组患者血清Cor水平较T1时点均降低(P<0.05);对照组患者T4时点Cor水平高于T1、T2、T3时点(P<0.05)。试验组术中瑞芬太尼、丙泊酚使用剂量均低于对照组(P<0.05)。试验组术后并发症发生率低于对照组(P<0.05)。结论 静脉全麻复合臂丛神经阻滞麻醉应用于肩部关节手术,有助于减少术中麻醉药物使用剂量,并降低患者围术期的应激反应,安全性良好。Objective To explore the effect of intravenous general anesthesia combined with brachial plexus block anesthesia in shoulder joint surgery and its influence on serum cortisol(Cor)of the patients.Methods From September 2020 to September 2022,84 patients received shoulder arthroscopic surgery in Anesthesia Department of the hospital,and the patients selected and randomly divided into the test group and the control group,with 42 patients in each group.The control group was given intravenous general anesthesia,and the test group was given intravenous general anesthesia combined with brachial plexus block anesthesia.The mean arterial pressure(MAP)and heart rate(HR)before the operation(T1),at the beginning of the operation(T2),30 minutes after the operation(T3),and 10 minutes after extubation(T4)was compared between the two groups serum cortisol(Cor).The intraoperative visual field clarity was evaluated by Likert 5-grade scoring method,and the operation time,amount of irrigation solution and postoperative complications of the two groups were recorded.Results MAP at T2,T3 and T4 in the test group was lower than that in control group(P<0.05).At T2,T3 and T4,MAP in test group and control group was lower than that at T1(P<0.05).MAP in control group was decreased gradually from T1 to T2 and T3,and recovered at T4.The difference at each time point was statistically significant(P<0.05).At T2,T3 and T4,MAP in test group and control group was lower than that at T1(P<0.05).Cor at T2,T3 and T4 in test group was lower than that in control group(P<0.05).At T2,T3 and T4,the Cor in test group and control group was lower than that at T1(P<0.05).Cor in control group was higher than that in T1,T2 and T3 at T4(P<0.05).The dosage of remifentanil and propofol in test group was lower than that in control group(P<0.05).The incidence of postoperative complications in test group was lower than that in control group(P<0.05).Conclusion The application of intravenous general anesthesia combined with brachial plexus block anesthesia in shoulder jo

关 键 词：肩关节镜 静脉全身麻醉 神经阻滞麻醉 应激反应 

分 类 号：R614.4[医药卫生—麻醉学]