超声引导神经阻滞复合全身麻醉在肩锁关节脱位术中的应用

Application of ultrasound guided nerve block combined with general anesthesia in the operation of acromioclavicular joint dislocation

目的探讨超声引导下神经阻滞联合全身麻醉在肩锁关节脱位术中的应用价值。方法选取2018年1月~2019年12月西安交通大学第一附属医院收治的28例肩锁关节脱位患者为研究对象,按照入院顺序依次分为观察组与对照组,每组14例。观察组采用超声引导下神经阻滞复合全身麻醉,对照组采用全身麻醉。比较两组各个时间点平均动脉压(MAP)、心率(HR)、皮质醇和血管紧张素II的水平,评估围手术期血流动力学改变和机体应激反应。比较手术、麻醉、拔管、术毕至睁眼时间、麻醉药物用量、术后疼痛和镇静评分、不良反应发生率,评估两组麻醉效果的差异性。结果与对照组比较,观察组的MAP和HR在手术切皮和拔除气管插管时显著降低,皮质醇和血管紧张素II在术毕拔管和术后24 h显著降低,丙泊酚和舒芬太尼的用量显著减少,VAS评分和镇静评分在术后各个时间点显著降低,头晕、恶心呕吐发生率显著降低(均P<0.05)。结论超声引导下神经阻滞复合全身麻醉在肩锁关节脱位术中具有重要意义,可以降低机体应激反应,维持术中生命体征平稳;减少全身静脉麻醉药物的用量,减少不良反应发生的概率;增加术后镇痛镇静的效果,减少止痛药物的用量,可在临床推广应用。

Objective To explore the application value of ultrasound-guided nerve block combined with general anesthesia in the treatment of acromioclavicular joint dislocation.Methods 28 patients with acromioclavicular dislocation were randomly divided into observation group(ultrasound-guided nerve block combined with general anesthesia)and control group(general anesthesia).Mean arterial pressure(MAP),heart rate(HR),cortisol and angiotensin II were used to evaluate hemodynamic changes and stress response perioperatively.The time period of operation,anesthesia,extubation and resuscitation,the dosage of anesthetic drugs,postoperative pain and sedation scores and the incidence of side effects were used to evaluate the anesthesia effect.Results Compared with the control group,the observation group has lower level of MAP and HR during the time of incision and intubation,less cortisol and angiotensin II after extubation and 24 hours after operation,the lower dosage of propofol and sufentanil,lower VAS score and sedation score after operation.The incidence of dizziness,nausea and vomiting was significantly smaller in observation group than that in control group(P<0.05).Conclusion Ultrasound guided nerve block combined with general anesthesia has great value in the treatment of acromioclavicular joint dislocation.It can significantly reduce the stress response,maintain stable vital signs during the operation,lower the dosage of drugs for anesthesia and pain,it also has fewer side effects,which means it is worthy of clinical application.