静吸复合全麻联合连续臂丛神经阻滞对肩关节镜手术控制性降压的临床观察

Effect of general anesthesia combined with continuous interscalene brachial plexus block on controlled hypotension during arthroscopic shoulder surgery

目的探讨肩关节镜手术采取静吸复合全麻联合连续臂丛神经阻滞麻醉方式在控制性降压及术后镇痛方面的临床效果。方法选取择期行肩关节镜手术的患者116例,随机分为A、B两组。A组麻醉方式采取静吸复合全麻联合连续臂丛神经阻滞。先在超声引导下行肌间沟臂丛神经阻滞并留置导管,然后行静吸复合全麻。B组麻醉方式采取静吸复合全麻。两组全麻诱导及维持用药相同。术中MAP控制在50~65 mmHg之间,当麻醉深度适宜MAP升高超过65 mmHg时,给予静脉泵注硝酸甘油进行控制性降压。记录患者术中MAP、HR,全麻维持用药量及硝酸甘油用药情况。A组患者术后采用连续臂丛神经阻滞镇痛,B组患者采用静脉镇痛。分别记录术后24 h、48 h视觉模拟评分(VAS),术后恶心、呕吐情况及患者满意度。结果与B组患者相比,A组患者术中MAP、HR更平稳,全麻维持用药量及硝酸甘油用量明显减少。A组患者术后恶心呕吐发生率低,患者满意度高。结论肩关节镜手术采用静吸复合全麻联合连续臂丛神经阻滞的麻醉方式,更有利于术中控制性降压的管理,维持血流动力学的稳定,可以减少全麻药及硝酸甘油的用量,同时提供更满意的术后镇痛。

Objective To evaluate the efficacy of general anesthesia combined with continuous interscalene brachial plexus block on controlled hypotension and post-operative analgesia during arthroscopic shoulder surgery. Methods A total of 116 patients undergoing arthroscopic shoulder surgery were randomly divided into group A or group B. Group A received general anesthesia combined with continuous interscalene brachial plexus block. Group B received general anesthesia. A catheter for continual monitoring of arterial pressure was inserted in the radial artery. The intra-operative MAP was maintained at a target of 50 ~ 65 mmHg. The nitroglycerin was used to control blood pressure when the MAP rises above 65 mmHg. Postoperatively,group A received CISB and group B received PCIA. The MAP andHR was recorded every five minutes. The consumption of general anesthetics and nitroglycerin,the VAS of 24h/48 h after surgery,the incidence postoperative nausea and vomit,and the satisfaction of analgesia were recorded. Results Compared to group B,the MAP andHR were more stable,the consumption of general anesthetics and nitroglycerin was less,the incidence of postoperative nausea and vomit was lower and the level of patient satisfaction was greater in group A. Conclusions General anesthesia combined with continuous interscalene brachial plexus block for arthroscopic shoulder surgery may achieve a better management of controlled hypotension, a stabilized hemodynamic, a markedly reduced consumption of general anesthetics and nitroglycerin,superior analgesia with greater patient satisfaction.