肌间沟臂丛神经阻滞复合静脉全麻对肩关节镜手术患者麻醉效果、MAP、HR以及血清Cor、NE的影响

Effects of Intermuscular Groove Brachial Plexus Block Combined with Intravenous General Anesthesia on Anesthesia Effect,MAP,HR and Serum Cor,NE in Patients Underwent Shoulder Arthroscopic Surgery

目的:分析B超指引下实施肌间沟臂丛神经阻滞复合静脉全麻对肩关节镜手术患者麻醉效果、心率(HR)、平均动脉压(MAP)以及血清皮质醇(Cor)、去甲肾上腺素(NE)水平的影响。方法:选择本院2016年3月至2019年12月收治的80例肩关节镜手术患者,以随机数字表法作为分组原则(每组样本容量40例),对照组实施单纯全凭静脉麻醉,实验组实施B超指引下肌间沟臂丛神经阻滞复合静脉全麻,对比两组不同时点MAP、HR、血清Cor、NE水平以及瑞芬太尼、尼群地平(NIT)、丙泊酚使用剂量,并对比两组并发症发生情况。结果:实验组T1-4时点MAP、HR、血清Cor、NE水平均明显低于对照组(P<0.05),瑞芬太尼、NIT以及丙泊酚使用剂量实验组均明显较对照组减少(P<0.05);两组并发症发生率比较未见统计学差异(P>0.05)。结论:B超指引下肌间沟臂丛神经阻滞复合静脉全麻应用于肩关节镜手术中可抑制患者体内应激物质释放,将MAP及HR维持在稳定范围内,极大地减少了麻醉药物、NIT使用剂量,麻醉效果理想、确切。

Objective:To analyze the effects of intermuscular groove brachial plexus block combined with intravenous general anesthesia under the guidance of B-ultrasound on anesthesia effect,heart rate(HR),mean arterial pressure(MAP)and serum cortisol(COr),noradrenaline(NE)levels in patients underwent shoulder arthroscopic surgery.Methods:80 patients who were underwent shoulder arthroscopic surgery in our hospital from March 2016 to December 2019 were selected,used random number table method as grouped principle(40 cases in each group),the control group was anesthetized by intravenous anesthesia alone,the experimental group was used intermuscular groove brachial plexus block combined with intravenous general anesthesia under the guidance of B-ultrasound.The levels of MAP,HR,serum COr,NE and the dosages of remifentanil,nitrendipine(NIT),propofol were compared between the two groups in different time points.The complications of the two groups were compared.Results:The levels of MAP,HR,serum Cor and NE in the experimental group at T1-4 time points were significantly lower than those in the control group(P<0.05),the dosages of remifentanil,NIT and propofol in the experimental group were significantly lower than those in the control group(P<0.05).There was no statistical difference in the incidence of complications between the two groups(P>0.05).Conclusion:Intravenous general anesthesia combine with intermuscular groove brachial plexus block under the guidance of B-ultrasound can inhibit the release of stress substances in the patients undergoing shoulder arthroscopic surgery,keep MAP and HR stable,reduce the dosages of narcotic drugs and NIT greatly,the anesthesia effect is ideal and accurate.