超声引导下神经阻滞预防性镇痛在肩关节镜手术中的临床效果观察

Clinical application of ultrasound-guided nerve block preemptive analgesia in shoulder arthroscopic surgery

目的探讨神经阻滞预防性镇痛对肩关节镜手术中的血流动力学和镇痛的临床效果。方法选取60例接受在侧卧牵引位下行择期单侧肩关节镜手术患者为研究对象,随机分为单纯全身麻醉组(GA组,n=30)和神经阻滞复合全身麻醉组(NA组,n=30)。记录患者入室(T_(0))、切皮时(T_(1))、手术开始10 min(T_(2))、手术开始30 min(T_(3))、手术开始1 h(T_(4))、出室(T_(5))时间段的心率(HR)和平均动脉压(MAP);记录手术中输液量、尿量、出血量及冲洗液中肾上腺素使用量,术中及术后阿片类药物的用量及其他麻醉药物的使用情况;记录手术时长、麻醉时长、拔管时间、恢复室恢复时间(PACU恢复时间)、术后并发症、住院天数;记录拔管后5 min、术后1 h、术后4 h、术后8 h、术后16 h、术后24 h的疼痛视觉模拟评分(VAS)。结果NA组患者在T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时间段的HR、MAP明显低于GA组,2组间比较差异有统计学意义(P<0.05);NA组患者舒芬太尼使用量、瑞芬太尼使用量、丙泊酚使用量、拔管时间、PACU恢复时间都明显低于GA组,2组间比较差异有统计学意义(P<0.05);NA组患者在拔管后5 min、术后1 h、术后4 h、术后8 h、术后16 h的VAS评分都明显低于GA组,2组间比较差异有统计学意义(P<0.05);2组间一般情况、输液量、尿量、出血量、麻醉时长、手术时长、肾上腺素使用量、住院天数及相关并发症比较,差异无统计学意义(P>0.05)。结论超声引导下神经阻滞预防性镇痛能提高肩关节镜手术的麻醉质量,提高患者整体满意度而没有增加并发症发生的风险。

Objective To investigate the clinical value of nerve block preemptive analgesia on hemodynamics and analgesia during shoulder arthroscopic surgery.Methods 60 patients underwent elective unilateral shoulder arthroscopic surgery under lateral traction position were selected as the research objects.60 patients were divided into simple general anesthesia group(GA group,n=30)and nerve block combined general anesthesia group(NA group,n=30).Heart rate(HR)and mean arterial pressure(MAP)were recorded at five times(T_(0),T_(1),T_(2),T_(3),T_(4) and T_(5)),T_(0) as entering the operating room,T_(1) as skin incision,T_(2) as 10 mins after the beginning of surgery,T_(3) as 30 mins after the beginning of surgery,T_(4) as 1h after the beginning of surgery and T_(5) as out of surgery.The volume of fluid infusion,urine volume,blood loss,the amount of epinephrine in the flushing fluid,the requirements of opioids,the use of other anesthetic drugs during and after operation were also recorded.The operation time,anesthesia time,extubation time,recovery time(PACU recovery time),postoperative complications,length of hospital stay were recorded.Visual Analogue Scale(VAS)scores at 5mins after trachea extubation and 1 h,4 h,8 h,16 h and 24 h after surgery also recorded.Results The HR and MAP of patients in the NA group at T_(1),T_(2),T_(3),T_(4) and T_(5) were significantly lower than those in the GA group,and the differences between the two groups were statistically significant(P<0.05).The requirements of sufentanil,remifentanil,propofol,extubation time,and PACU recovery time in NA group were significantly lower than those in GA group,and the differences were statistically significant(P<0.05).The VAS scores of patients in NA group were significantly lower than those in GA group at 5 mins after trachea extubation and 1 h,4 h,8 h,16 h after surgery,and the differences between the two groups were statistically significant(P<0.05).There were no significant differences in general conditions,infusion volume,urine volume,blood loss,anesthesia duration,operation duration,epinephrine requirements,length of hospital stay and related complications between the two groups(P<0.05).Conclusion Nerve block combined with general anesthesia can improve the anesthesia quality of shoulder arthroscopic surgery,and improve the overall satisfaction of patients without increasing the risk of complications.