改良盲探肌间沟臂丛神经阻滞对肩关节手术患者的疗效分析

The effect of modified blind probing intermuscular sulcus brachial plexus block in patients undergoing shoulder surgery

目的:探讨改良盲探肌间沟臂丛神经阻滞对肩关节手术患者的疗效分析,并探讨其对血清神经生长因子(Nerve growth factor,NGF)、转化生长因子β1(Transforming growth factor beta,TGF-β1)水平的影响。方法:选择2017年2月至2020年7月在本院进行肩关节手术患者170例,根据随机信封抽签将患者分为改良组与传统组各85例。两组均行常规静吸复合全身麻醉,改良组术后行改良盲探肌间沟臂丛神经阻滞,传统组术后行一次异感法盲探肌间沟臂丛神经阻滞。记录NGF及TGF-β1水平变化情况。结果:本研究两组患者均顺利完成手术,且未发生严重不良反应。改良组用药后30 min的桡神经、尺神经、正中神经、肌皮神经的完全阻滞率与传统组对比,差异无统计学意义(P<0.05)。改良组的镇痛持续时间、运动阻滞恢复时间、局麻药物使用总量都少于传统组(P<0.05)。改良组术后1、3、7 d的VAS疼痛评分与对照组对比,差异无统计学意义(P<0.05)。两组术后7 d的血清NGF及TGF-β1含量高于术后1 d(P<0.05),改良组也高于对照组(P<0.05)。结论:改良盲探肌间沟臂丛神经阻滞在肩关节手术患者的应用不会影响各神经的完全阻滞率以及患者的镇痛效果,且能促进NGF及TGF-β1的释放,从而提高总体麻醉质量。

Objective:To investigate the effect of modified blind probing intermuscular sulcus brachial plexus block in patients undergoing shoulder surgery,and investigate the influence on the serum levels of nerve growth factor(NGF)and transforming growth factor beta(TGF-β1).Methods:170 patients who underwent shoulder surgery in our hospital from February 2017 to July 2020 were selected and divided into improved group and traditional group according to random envelope drawing,with 85 cases in each group.Both groups were underwent conventional intravenous inhalation combined with general anesthesia,the modified group underwent modified blind exploration of the intermuscular sulcus brachial plexus block after operation,and the traditional group were given blind detection of intermuscular sulcus brachial plexus block,and the changes of NGF and TGF-β1 levels were recorded.Results:Two groups were successfully completed the operation,and no serious adverse reactions occurred.There was no significant difference in the complete block rate of radial nerve,ulnar nerve,median nerve and musculocutaneous nerve at 30 min after medication between the improved group and the traditional group(P<0.05).The duration of analgesia,recovery time from motor block,and total amount of local anesthetics in the modified group were less than those in the traditional group(P<0.05).There were no significant difference in the pain VAS scores of the modified group at 1 d,3 d and 7 d after the operation compared with the control group(P<0.05).The levels of serum NGF and TGF-β1 at 7 days after operation in the two groups were higher than 1 day after operation(P<0.05),and the modified group were also higher than that in the control group(P<0.05).Conclusion:The application of modified blind probing intermuscular sulcus brachial plexus nerve block in patients undergoing shoulder surgery will not affect the complete block rate of each nerve,nor will it affect the patient’s analgesic effect,and can increase NGF and TGF-β1 release,thereby improve the overall anesthesia quality.