超声引导上干臂丛神经阻滞用于肩部手术的麻醉效果及对膈肌功能的影响

The anesthetic effect of ultrasound-guided superior trunk brachial plexus block in shoulder surgery and its effect on diaphragm function

目的探讨上干臂丛神经阻滞在肩部手术的麻醉效果及其对膈肌功能的影响。方法选择2020年4月至2021年3月鹤山市人民医院及中山大学附属第五医院肩部手术患者68例,在超声引导下进行神经阻滞,采用随机数字表法,分为上干臂丛神经阻滞组(S组,n=33)与肌间沟臂丛神经阻滞组(I组,n=35)。于神经阻滞前及神经阻滞后30分钟经超声对膈肌功能进行评估,比较两组患者呼吸频率、血氧饱和度和深呼吸状态下同侧膈肌移动度、膈肌麻痹发生率。评价麻醉效果,记录术后肩臂部感觉、运动恢复时间及神经阻滞并发症发生情况。结果两组患者麻醉效果相近[72.73%vs 82.86%],差异无统计学意义(P>0.05)。与S组比较,I组神经阻滞后30分钟膈肌移动度[(4.10±2.10)cm vs(6.02±1.35)cm]降低、呼吸频率[(17.29±1.84)次/分vs(16.27±1.61)次/分]增快、膈肌麻痹发生率[57.14%vs 6.06%]增高,术后肩臂部感觉、运动功能恢复较缓慢,霍纳氏综合征、声音嘶哑明显增多,差异有统计学意义(P<0.05)。结论超声引导上干臂丛神经阻滞用于肩部手术在获得满意麻醉效果的同时,能明显降低膈肌麻痹、霍纳氏综合征、声音嘶哑发生率,术后肩臂部运动、感觉功能恢复较快。

Objective To investigate the anesthetic effect of superior trunk brachial plexus block in shoulder surgery and evaluate its effect on diaphragm function.Methods From April 2020 to March 2021,patients undergoing selective shoulder surgery were randomly divided into the group of 33 cases of superior trunk brachial plexus block(group S)and the group of 35 cases of intermuscular sulcus brachial plexus block(group I).All patients received nerve block guided by ultrasound,and their diaphragm function was evaluated 30 minutes before and after nerve block by ultrasound.The respiratory rate,SpO_(2) and mobility of lateral diaphragm were recorded before and 30 minutes after nerve block,thenthe incidence of diaphragm paralysis was calculated.The anesthetic effect was evaluated 30 minutes after nerve block.Postoperative sensory and motor recovery time and complications of brachial plexus block were recorded.Results There was no significant difference between two groups in anesthesia effect(72.73%vs 82.86%,P>0.05).Compared with group S,the diaphragm mobility[(4.10±2.10)cm vs(6.02±1.35)cm],respiratory rate[(17.29±1.84)vs(16.27±1.61)],incidence of diaphragm paralysis(57.14%vs 6.06%)and motor and sensory function 30 minutes after nerve block were significantly reduced in group I,while the recovery time of motor and sensory function,the incidence of Horner’s syndrome and hoarseness significantly increased(P<0.05).Conclusions Ultrasound-guided superior trunk brachial plexus block not only providessatisfied anesthetic effect in shoulder surgery,but also significantly reduces the incidence of diaphragmatic paralysis,Horner’s syndrome and hoarseness.The motor and sensory function of shoulder and arm recover quickly after operation.