超声引导不同入路的臂丛神经阻滞联合脑电双频指数监测对肩关节镜下患者的麻醉效果分析

Analysis of the anesthetic effect of brachial plexus block with different ultrasound-guided approaches combined with bispeetral index monitoring in patients under shoulder arthroscopy

目的 探讨超声引导不同入路的臂丛神经阻滞联合脑电双频指数(BIS)监测对肩关节镜下患者的麻醉效果。方法 前瞻性选取2020年1月至2022年7月来亳州市人民医院行肩关节镜手术的患者90例,按照随机数字表法将患者分为对照组与观察组,每组各45例。对照组患者行BIS监测下锁骨上入路臂丛神经阻滞复合全身麻醉,观察组行BIS监测下腋路臂丛神经阻滞复合全身麻醉。比较两组患者手术室时(T0)、气管插管即刻(T1)、切皮时(T2)、拔管(T3)的心率、平均动脉压水平;比较两组患者术中的七氟烷及舒芬太尼用量;比较两组患者在麻醉后恢复室中、术后6 h、12 h的疼痛评分和肌力评分;观察两组患者麻醉后的不良反应发生情况。结果 两组在T0、T3点的心率、平均动脉压比较,差异无统计学意义(P>0.05);观察组在T1、T2点的心率为(78.10±10.23)、(71.34±8.78)次/min,平均动脉压为(100.09±8.78)、(95.23±7.89) mmHg,均明显较对照组[(82.78±9.89)、(78.99±10.23)次/min和(110.45±9.23)、(104.45±10.55) mmHg]低,差异均有统计学意义(P<0.05)。观察组术中的七氟烷及舒芬太尼用量为(25.31±3.21) mL、(14.09±2.12)μg,明显较对照组[(34.09±5.45)mL、(26.78±4.34)μg]低,差异均有统计学意义(P<0.05)。观察组在麻醉后恢复室中、术后6 h、12 h的疼痛评分为(3.10±0.78)、(2.45±0.56)、(1.67±0.34)分,明显较对照组[(5.56±1.23)、(4.67±1.03)、(3.89±1.20)分]低,肌力评分为(4.38±0.98)、(4.56±1.02)、(4.78±1.23)分,明显较对照组[(3.09±0.67)、(3.45±0.99)、(3.89±1.09)分]高,差异均有统计学意义(P<0.05)。观察组的不良反应发生率为2.22%,较对照组(13.33%)低,但组间对比差异无统计学意义(P>0.05)。结论 与超声引导下锁骨上入路臂丛神经阻滞相比,超声引导腋路臂丛神经阻滞联合BIS监测下肩关节镜下患者的血流动力学平稳,应激反应小,术后疼痛程度轻,对患者的肌力影响小,应用安全。

Objective To investigate the anesthetic effect of brachial plexus block with different ultrasound-guided approaches combined with bispeetral index(BIS) monitoring in patients under shoulder arthroscopy. Methods A total of 90 patients who came to the People’s Hospital of Bozhou for shoulder arthroscopic surgery from January 2020 to July 2022 were prospectively selected, and were divided into the control group and the observation group according to the method of random number table, with 45 patients in each group. The control group were given brachial plexus block via supraclavicular approach combined with general anesthesia under BIS monitoring was performed, the observation group were given axillary brachial plexus block combined with general anesthesia under BIS monitoring. The heart rate and mean arterial pressure levels of the two groups were compared at entering the operating room(T0), immediate endotracheal intubation(T1), skin incision(T2), extubation(T3), the amount of sevoflurane and sufentanil during operation were compared between the two groups, the pain scores and muscle strength scores of the two groups were compared in the recovery room after anesthesia, 6 hours and 12 hours after surgery, and the incidence of adverse reactions after anesthesia was compared between the two groups. Results There was no difference in heart rate and mean arterial pressure between the two groups at T0 and T3(P>0.05);the heart rate at T1 and T2 in the observation group were(78.10±10.23),(71.34±8.78) times/min, and the mean arterial pressure were(100.09±8.78),(95.23±7.89) mmHg, which were significantly lower than those in the control group [(82.78±9.89),(78.99±10.23) times/min, and(110.45±9.23),(104.45±10.55) mmHg], the differences were statistically significant(P<0.05). The dosages of sevoflurane and sufentanil in the observation group were(25.31±3.21) mL,(14.09±2.12) μg, which were lower than those in the control group[(34.09±5.45) mL,(26.78±4.34) μg], the differences were statistically significant(P<0.05). The pain scores in the recovery room after anesthesia, 6 h and 12 h after surgery in the observation group were(3.10±0.78),(2.45±0.56),(1.67±0.34) points, which were lower than that in the control group[(5.56±1.23),(4.67±1.03),(3.89±1.20) points], and the muscle strength scores were(4.38±0.98),(4.56±1.02),(4.78±1.23) points, which were higher than those in the control group[(3.09±0.67),(3.45±0.99),(3.89±1.09) points], the differences were statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 2.22%, which was lower than that in the control group(13.33%), but there was no statistical significance between the two groups(P>0.05). Conclusion Compared with ultrasound-guided supraclavicular brachial plexus block, ultrasound-guided axillary brachial plexus block combined with BIS monitoring under shoulder arthroscopy has stable hemodynamics, less stress response, less postoperative pain, less impact on muscle strength, and safe application.