喉罩全身麻醉联合腋路臂丛神经阻滞对肱骨近端骨软骨瘤手术患者血流动力学及应激反应的影响  

Effect of laryngeal mask general anesthesia combined with axillary brachial plexus block on hemodynamics and stress response in patients undergoing surgery for osteochondroma of proximal humerus

作　　者：李晓欣 段志祥 邵甜 卢玉蓉 LI Xiao-xin;DUAN Zhi-xiang;SHAO Tian(Department of Anesthesiology,Yuncheng Central Hospital,Yuncheng Shanxi 044000,China)

机构地区：[1]运城市中心医院麻醉科,山西运城044000

出　　处：《临床和实验医学杂志》2024年第5期558-560,F0003,共4页Journal of Clinical and Experimental Medicine

基　　金：山西省科技厅重点研发计划(社会发展)项目(编号:201903D321161)。

摘　　要：目的探讨喉罩全身麻醉联合腋路臂丛神经阻滞对肱骨近端骨软骨瘤手术患者血流动力学、应激反应的影响。方法回顾性选取2017年1月至2022年11月在运城市中心医院行手术治疗的80例肱骨近端骨软骨瘤患者作为研究对象。按接受麻醉方案的不同将患者分为观察组和对照组,每组各40例。观察组术中采用喉罩联合腋路臂丛神经阻滞,对照组术中采用喉罩全身麻醉。观察并记录两组患者麻醉前(t_(0))、置入喉罩时(t_(1))及拔除喉罩时(t_(2))平均动脉压(MAP)及心率,统计两组患者苏醒时间及术后6、12和24 h的疼痛程度[视觉模拟评分法(VAS)评分],比较两组患者术前、术后4和12 h的应激反应指标[去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)、丙二醛、超氧化物歧化酶(SOD)]水平,统计麻醉恢复室中的并发症情况。结果t_(0)时,两组患者MAP及心率比较,差异均无统计学意义(P>0.05);t_(1)、t_(2)时,观察组患者MAP分别为(94.53±8.11)、(92.63±6.10)mmHg,心率分别为(119.35±10.18)、(120.41±9.55)次/min,均低于对照组[MAP:(113.71±8.45)、(116.55±8.66)mmHg;心率:(135.79±11.85)、(138.35±10.96)次/min],差异均有统计学意义(P<0.05)。观察组苏醒时间为(5.71±1.45)min,短于对照组[(10.93±2.21)min],差异有统计学意义(P<0.05)。两组术后4、12、24 h VAS评分均逐渐降低,差异均有统计学意义(P<0.05),但组间比较差异均无统计学意义(P>0.05)。术后4、12 h,观察组NE、AngⅡ、丙二醛水平均显著低于对照组,SOD水平明显高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为10.00%,稍低于对照组(27.50%),但两组比较,差异无统计学意义(P>0.05)。结论喉罩全身麻醉联合腋路臂丛神经阻滞应用于肱骨近端骨软骨瘤手术患者能有效维持稳定的血流动力学状态,缩短苏醒时间,减轻术后疼痛,抑制术后的应激反应,能够兼顾安全性与有效性。Objective To investigate the effects of laryngeal mask anesthesia combined with axillary brachial plexus block on hemodynamics and stress response in patients undergoing surgery for osteochondroma of proximal humerus.Methods Eighty patients with proximal humeral osteochondroma who underwent surgical treatment at Yuncheng Central Hospital from January 2017 to November 2022 were retrospectively selected as the study subjects,and they were divided into the observation group and the control group according to different anesthesia methods,with 40 cases in each group.The observation group was treated with laryngeal mask general anesthesia combined with axillary brachial plexus block,and the control group was treated with laryngeal mask general anesthesia.The mean arterial pressure(MAP)and heart rate of two groups of patients were observed and recorded before anesthesia(t_(0)),during the insertion of laryngeal mask(t_(1)),and during the removal of laryngeal mask(t_(2)).The recovery time,postoperative pain[visual analog scale(VAS)score]levels at 6,12,and 24 hours after surgery of two groups of patients were statistically analyzed.The levels of stress response indicators[(norepinephrine(NE),angiotensinⅡ(AngⅡ),malondialdehyde]were compared between two groups of patients before surgery and 4 and 12 hours after surgery.Results At t_(0),there was no statistically significant difference in MAP and heart rate between the two groups of patients(P>0.05);at t_(1)and t_(2),the MAP of the observation group patients were(94.53±8.11),(92.63±6.10)mmHg,and the heart rates were(119.35±10.18)and(120.41±9.55)beats/min,respectively,which were lower than those of the control group[MAP:(113.71±8.45)and(116.55±8.66)mmHg;heart rates:(135.79±11.85)and(138.35±10.96)beats/min],and the differences were statistically significant(P<0.05).The awakening time of the observation group was(5.71±1.45)minutes,which was shorter than that of the control group[(10.93±2.21)minutes],and the difference was statistically significant(P<0.05).The VAS s

关 键 词：骨软骨瘤 血流动力学 腋路臂丛神经阻滞 喉罩全身麻醉 应激反应 

分 类 号：R614[医药卫生—麻醉学] R738.1[医药卫生—外科学]