连续臂丛阻滞用于肩-手综合征镇痛疗效观察

Effect of Brachial Plexus Block on Shoulder-hand Syndrome

目的观察臂丛神经阻滞对肩-手综合征的疗效。方法30例初发脑卒中(病程≤3个月)并发肩-手综合征患者随机分为A组(对照组)和B组(臂丛阻滞组),每组15例。结合中枢性运动障碍恢复的特点(弛缓期-痉挛期-恢复期),两组患者均有步骤地进行康复训练,但B组同时在患侧穿刺留置连续臂丛麻醉导管,持续注射罗哌卡因和地塞米松注射液。通过视觉模拟评分(VAS)评估上肢疼痛,采用Fugl-Meyer法(FMA)评定上肢关节被动活动范围、上肢及腕手关节的运动功能。结果A组上肢疼痛评分治疗20d后低于治疗前(P<0.05),B组上肢疼痛评分治疗10d即明显下降(P<0.01),且明显低于A组(P<0.01);治疗10d后,两组患者的上肢运动评分均明显提高,上肢关节肿胀明显减轻(均P<0.01),但B组的疗效优于A组(P<0.05)。结论脑卒中后瘫痪侧上肢臂丛神经持续注射罗哌卡因可以减轻上肢疼痛,提高上肢运动能力,减轻患侧关节肿胀。

Objective To observe the effect of brachial plexus block with ropivacaine and dexamethasone injecting on shoulderhand syndrome （SHS） in stroke patients. Methods Thirty stroke patients complicated with SHS were randomly divided into the control group and trial group with 15 cases in each group. All patients of two groups received rehabilitation treatment, including the corrective positioning of limbs and trunk, physical exercise training, massage therapy, as well as psychological intervention. The trial group was added treatment of brachial plexus block with ropivacaine and dexamethasone injecting. The therapeutic effect was assessed with Visual Analogous Score （VAS） and Fugl-Meyer Assessment （FMA）. Results The efficacy of the trial group was significantly superior to that of the control group. After treatment, the VAS score of the trial group on shoulder pain decreased obviously and was significantly lower than that of the control group （ P 〈0.01）. The FMA score of the trial group was higher than that of the control group （ P 〈0.05）. The range of motion of joint of the trial group was superior to that of the control group （ P 〈0.05）. Conclusion Brachial plexus block with ropivacaine and dexamethasone injecting has significant effectiveness on stroke patients complicated with SHS, and is helpful to recover the function of shoulder joint.