超声引导下肌间臂丛麻醉用于肩关节镜手术的效果观察  

Effects of ultrasound-guided intermuscular brachial plexus anesthesia on shoulder arthroscopic surgery

作　　者：葛凌云 罗珉 Ge Lingyun;Luo Min(Department of Anesthesiology,Dongyang Hospital of Traditional Chinese Medicine,Dongyang 322100,Zhejiang Province,China;Department of Orthopedics,Dongyang Hospital of Traditional Chinese Medicine,Dongyang 322100,Zhejiang Province,China)

机构地区：[1]东阳市中医院麻醉科,东阳322100 [2]东阳市中医院骨科,东阳322100

出　　处：《中国基层医药》2025年第2期204-209,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察超声引导下肌间臂丛麻醉用于肩关节镜手术的效果。方法前瞻性选取2022年1月至2023年1月东阳市中医院收治的行肩关节手术治疗的患者300例为研究对象,采用随机对照研究方法,根据随机数字表法将其分为观察组(n=150)和对照组(n=150)。对照组采用静脉全身麻醉,观察组采用肌间沟臂丛神经阻滞复合静脉全身麻醉。比较两组临床疗效、手术指标、血流动力学水平、不良反应发生率。结果观察组术后2 h、3 h的视觉模拟评分法(VAS评分)、屈肘和屈腕肌力评分分别为(4.12±0.21)分、(2.32±0.62)分、(3.35±0.61)分、(4.19±0.57)分,均优于对照组的(6.54±0.32)分、(1.21±0.23)分、(4.62±0.21)分、(3.25±0.63)分,差异均有统计学意义(t=77.44、20.56、-24.11、13.55,均P<0.01)。观察组的术中灌洗液用量、瑞芬太尼和丙泊酚用量、手术时间分别为(6.32±2.11)L、(0.13±0.03)μg·kg^(-1)·min^(-1)、(0.11±0.03)mg·kg^(-1)·h^(-1)、(73.23±15.86)min,均少于或短于对照组的(8.52±3.231)L、(0.15±0.02)μg·kg^(-1)·min^(-1)、(0.15±0.02)mg·kg^(-1)·h^(-1)、(79.88±15.56)min。观察组手术视野清晰度为(1.02±0.21)分,优于对照组的(1.75±0.32)分,差异均有统计学意义(t=6.98、-6.79、-13.59、-3.67、-23.36,均P<0.01)。观察组在手术开始时(T1)、术中30 min(T2)的收缩压分别为(106.65±7.12)mmHg(1 mmHg=0.133 kPa)、(97.02±5.01)mmHg,均低于对照组(108.69±7.21)mmHg、(98.26±5.12)mmHg,差异均有统计学意义(t=-2.47、-2.12,均P<0.05);观察组在T1、T2、术中60 min(T3)、拔管后10 min(T4)的心率分别为(71.69±5.32)次/min、(62.32±4.85)次/min、(61.12±4.25)次/min、(79.28±3.52)次/min,均低于对照组的(91.23±5.21)次/min、(90.12±4.63)次/min、(92.21±4.31)次/min、(92.32±3.51)次/min,差异均有统计学意义(t=-32.14、-50.78、-62.91、-32.13,均P<0.01)。观察组发生过敏、恶心、呕吐、头晕等不良反应总发生率28.67%(43/150),低于对照组的Objective:To investigate the effects of ultrasound-guided intermuscular brachial plexus anesthesia on shoulder arthroscopic surgery.Methods:A total of 300 patients who underwent shoulder arthroscopic surgery at Dongyang Hospital of Traditional Chinese Medicine from January 2022 to January 2023 were prospectively included in this study.A randomized controlled trial design was used.The patients were divided into an observation group(n=150)and a control group(n=150)using a random number table method.The control group received intravenous general anesthesia,while the observation group underwent intermuscular brachial plexus nerve block combined with intravenous general anesthesia.The clinical efficacy,surgical indicators,hemodynamic levels,and incidence of adverse reactions were compared between the two groups.Results:The Visual Analog Scale(VAS)scores and the muscle strength scores for elbow and wrist flexion in the observation group at 2 and 3 h postoperatively were(4.12±0.21),(2.32±0.62),(3.35±0.61),and(4.19±0.57),respectively.There values were significantly superior to those in the control group[(6.54±0.32),(1.21±0.23),(4.62±0.21),(3.25±0.63),t=77.44,20.56,-24.11,13.55,all P<0.01].The intraoperative lavage fluid volume,remifentanil dosage,propofol dosage,and duration of surgery in the observation group were(6.32±2.11)L,(0.13±0.03)μg·kg^(-1)·min^(-1),(0.11±0.03)mg·kg^(-1)·h^(-1),and(73.23±15.86)min,respectively,all of which were significantly lower than those in the control group[(8.52±3.23)L,(0.15±0.02)μg·kg^(-1)·min^(-1),(0.15±0.02)mg·kg^(-1)·h^(-1),and(79.88±15.56)min,t=6.98,-6.79,-13.59,-3.67,all P<0.01].The clarity of the surgical field in the observation group was rated at(1.02±0.21)points,which was significantly higher than that in the control group[(1.75±0.32)points,t=-23.36,P<0.01].At the start of surgery(T1)and 30 min into the procedure(T2),the systolic blood pressures in the observation group were(106.65±7.12)mmHg(1 mmHg=0.133 kPa)and(97.02±5.01)mmHg,which were significantl

关 键 词：臂神经丛阻滞 麻醉 全身 内窥镜检查 麻醉和镇痛 超声检查 介入性 肩关节 血压 血流动力学 

分 类 号：R614[医药卫生—麻醉学]