超声引导下肩胛上神经阻滞与肌间沟臂丛神经阻滞复合全身麻醉在肩关节镜手术中的效果比较  

Comparison of the effect of ultrasound-guided suprascapular nerve block and intermuscular sulcus brachial plexus nerve block combined with general anesthesia in arthroscopic shoulder surgery

作　　者：文伟红 温小林[2] 何应钦 WEN Wei-hong;WEN Xiao-lin;HE Ying-qin(Department of Anesthesiology,People′s Hospital of Xindu District,in Chengdu City,Sichuan Province,Chengdu 610500,China;Department of Anesthesiology,the First Affiliated Hospital of Chengdu Medical College,Sichuan Province,Chengdu 610000,China)

机构地区：[1]四川省成都市新都区人民医院麻醉科,四川成都610500 [2]成都医学院第一附属医院麻醉科,四川成都610000

出　　处：《河北医科大学学报》2025年第3期274-280,共7页Journal of Hebei Medical University

基　　金：四川省科技厅科研项目(2023NSFSC1571)。

摘　　要：目的比较肩关节镜手术中超声引导下肩胛上神经阻滞(suprascapular nerve block,SSB)与肌间沟臂丛神经阻滞(interscalene plexus block,ISB)分别复合全身麻醉的临床效果。方法选取四川省成都市新都区人民医院和成都医学院第一附属医院行肩关节镜手术的91例患者,经计算机随机数字生成表分为ISB组(超声引导下ISB复合全身麻醉)45例和SSB组(超声引导下SSB复合全麻)46例。比较2组入室时、手术开始后30 min、术毕心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、麻醉药物用量、手术时间及恢复室停留时间;比较2组术后1、6、12、24 h疼痛情况、屈腕肌力及屈肘肌力;比较2组术前、术后24 h应激反应、炎症介质指标差值;比较2组并发症发生情况。结果2组HR、MAP均在手术开始后30 min较术前降低,后于术毕升高,2组间比较差异无统计学意义,时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.001)。2组的神经阻滞成功率均为100%,无神经阻滞失败或重复行神经阻滞的情况发生。2组丙泊酚用量、瑞芬太尼用量、手术时间、恢复室停留时间比较差异均无统计学意义(P>0.05)。2组术后疼痛视觉模拟量表(visual analogue scale,VAS)评分随着时间的延长呈现降低的趋势,ISB组比SSB组下降趋势更明显,2组组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.001),2组术后屈腕肌力、屈肘肌力随着时间的延长逐增强,组间比较差异无统计学意义(P>0.05),时点间、组间·时点间交互作用比较差异均有统计学意义(P<0.001)。ISB组术前与术后24 h醛固酮(aldosterone,ALD)、促肾上腺皮质激素(adreno cortico tropic hormone,ACTH)差值均高于SSB组,差异均有统计学意义(P<0.05)。ISB组术前、术后24 h白细胞介素6(interleukin-6,IL-6)、前列腺素E2(prostaglandin E2,PGE2)差值均高于SSB组,差异均有统计学意义(P<0.05)。2组均未发生神经Objective To compare the clinical effect of ultrasound-guided suprascapular nerve block(SSB)combined with general anesthesia and interscalene brachial plexus block(ISB)combined with general anesthesia in arthroscopic shoulder surgery.Methods In total,91 patients who underwent arthroscopic shoulder surgery at People′s Hospital of Xindu District in Chengdu,Sichuan Province and First Affiliated Hospital of Chengdu Medical College were selected and randomly divided into the ISB group(ultrasound-guided ISB combined with general anesthesia,n=45)and the SSB group(ultrasound-guided SSB combined with general anesthesia,n=46)using a computer-generated random number table.The heart rate(HR),mean arterial pressure(MAP),anesthetic dosage,surgical duration,and length of recovery room stay between the two groups at the time of entry,at 30 min after surgery,and after surgery were compared.The pain levels,wrist flexion strength,and elbow flexion strength between the two groups at 1,6,12,and 24 h after surgery were compared.The stress response and differences in inflammatory mediator indicators between the two groups before and at 24 h after surgery and complications in the two groups were compared.Results HR and MAP in both groups were decreased at 30 min after the initiation of surgery compared with preoperative levels,and then increased at the end of the surgery.There was no significant difference between the two groups,but there were significant differences in the interaction between time points,groups,and time points between groups(P<0.001).The success rate of nerve block in both groups was 100%,with no occurrence of nerve block failure or repeated nerve block.There was no significant difference in the dosage of propofol and remifentanil,surgical duration,and the length of recovery room stay between the two groups(P>0.05).The visual analogue scale(VAS)scores of postoperative pain in the two groups showed a decreasing trend with the prolongation of time,with the ISB group showing a more significant downward trend than the SS

关 键 词：关节镜检查 肩胛上神经阻滞 肌间沟臂丛神经阻滞 

分 类 号：R684[医药卫生—骨科学]