比较不同麻醉方式对手法松解联合内热针导热治疗肩关节周围炎患者疗效的影响  

Comparison of efficacy of different anesthetic methods in patients with scapulohumeral periarthritis undergoing manual release combined with internal heat needle

作　　者：于俊敏[1] 孟超[1] 于俊杰[2] 马树银 綦光涛 孙艳芳 张静静[1] 武星[1] 尹燕伟[1] Yu Junmin;Meng Chao;Yu Junjie;Ma Shuyin;Qi Guangtao;Sun Yanfang;Zhang Jingjing;Wu Xing;Yin Yanwei(Department of Painology,Affiliated Hospital of Qingdao University,Qingdao City,Shandong Province 266000,China;Department of Pharmacy,Affiliated Hospital of Qingdao University,Qingdao City,Shandong Province 266000,China;Department of Neonatology,Affiliated Hospital of Qingdao University,Qingdao City,Shandong Province 266000,China;Department of Critical Care Medicine,Pingdu Second People's Hospital,Qingdao City,Shandong Province 266000,China)

机构地区：[1]青岛大学附属医院疼痛诊疗科,青岛市266000 [2]青岛大学附属医院药剂科,青岛市266000 [3]青岛大学附属医院新生儿科,青岛市266000 [4]平度市第二人民医院重症医学科,青岛市266000

出　　处：《中华疼痛学杂志》2024年第2期250-257,共8页Chinese Journal Of Painology

摘　　要：目的比较不同麻醉方式对手法松解联合内热针导热治疗肩关节周围炎(肩周炎)患者疗效的影响。方法选择2020年1月1日至2021年12月31日因肩周炎于青岛大学附属医院疼痛科就诊患者180例,性别、年龄不限。采用随机数字表法将其随机分为两组,每组90例,超声引导臂丛麻醉组采用超声引导下选择性臂丛麻醉,静脉麻醉组采用静脉麻醉。两组患者均实施肩关节手法松解术联合内热针导热治疗。记录治疗前、治疗后8 h及治疗后1、30、180 d的数字等级评分(NRS)、Constant-Murley肩关节功能评分及治疗后180 d时的治疗有效率,并记录患者开始功能锻炼时间、是否应用镇痛药物及不良反应发生情况。结果最终静脉麻醉组87例,臂丛麻醉组86例完成研究。两组患者一般资料比较差异均无统计学意义(P均>0.05)。两组间NRS评分差异有统计学意义(F=124.43,P<0.001);各时点间NRS评分差异有统计学意义(F=1248.85,P<0.001);治疗后8 h、1 d,臂丛麻醉组NRS评分均低于静脉麻醉组[(4.7±1.6)分比(8.1±0.8)分,(3.5±1.3)分比(4.9±1.4)分,P均<0.05]。两组间Constant-Murley评分差异有统计学意义(ADL:F=52.14,P<0.001;ROM:F=43.69,P<0.001);各时点间Constant-Murley评分差异有统计学意义(ADL:F=2605.39,P<0.001;ROM:F=2466.43,P<0.001);治疗后8 h和1 d,臂丛麻醉组Constant-Murley评分均高于静脉麻醉组(P均<0.05)。臂丛麻醉组开始功能锻炼时间早于静脉麻醉组[(8.0±2.8)h比(18.9±2.7)h,χ^(2)=684.88,P<0.001],且术后服用阿片类镇痛药物的患者例数较少[(4例比46例,χ^(2)=46.62,P<0.001]。治疗后180 d时,两组优良率差异无统计学意义[97.7%(85/87例)比97.7%(84/86例),χ^(2)=0.14,P=0.931]。结论手法松解联合内热针治疗肩周炎中,超声引导下选择性臂丛麻醉较静脉麻醉术后患者早期疼痛程度更轻,功能恢复更快,且无严重不良反应。Objective To compare the efficacy of different anesthetic methods in patients with scapulohumeral periarthritis undergoing manual release combined with internal heat needle.Methods One hundred and eighty patients with scapulohumeral periarthritis were selected from the Department of Painology,Affiliated Hospital of Qingdao University,from January 1,2020 to December 31,2021,regardless of sex and age.All patients were randomly divided into the brachial plexus block group and the intravenous anesthesia group(n=90),and were treated with manual release and internal heat needles.NRS,Constant-Murley score were recorded before the treatment,and 8 h,1 d,30 d and 180 d after the treatment.The effective rate at 180 days,and the adverse reactions were recorded.Results Eighty-seven cases in the intravenous anesthesia group and 86 cases in the brachial plexus block group finished the clinical trial.No differences were found in general data(all P>0.05).NRS had significant differences between two groups(F=124.43,P<0.001),and among each time point(F=1248.85,P<0.001).At 8 hours and 1 day after the treatment,NRS was lower in the brachial plexus block group than that in the intravenous anesthesia group[(4.7±1.6)vs.(8.1±0.8),(3.5±1.3)vs.(4.9±1.4),all P<0.05].Constant-Murley score had significant differences between two groups(ADL:F=52.14,P<0.001;ROM:F=43.69,P<0.001),and among each time point(ADL:F=2605.39,P<0.001;ROM:F=2466.43,P<0.001).At 8 hours and 1 day after the treatment,Constant-Murley score was higher in the brachial plexus block group than that in the intravenous anesthesia group(all P<0.05).The perioperative functional exercise was earlier in the brachial plexus block group than that in the intravenous anesthesia group[(8.0±2.8)h vs.(18.9±2.7)h,χ^(2)=684.88,P<0.001],and the number of patients taking opioid analgesics was less in the brachial plexus block group after the treatment[(4 cases vs.46 cases,χ^(2)=46.62,P<0.001].At 180 days after the treatment,there was no significant difference in the excellent and good rat

关 键 词：关节炎 肩关节 臂丛 超声引导 手法松解 内热针 

分 类 号：R686.3[医药卫生—骨科学]