超声引导下肌间沟入路臂丛神经上干阻滞在肩关节镜手术中的应用研究

Study on the Application of Superior Trunk Block of Brachial Plexus by Ultrasound-guided Intermuscular Groove Approach in Shoulder Arthroscopic Surgery

目的 探讨超声引导下肌间沟入路臂丛神经上干阻滞在肩关节镜手术中的应用效果。方法 选取2021年7月—2022年6月扬州大学建湖临床医学院收治肩关节镜手术患者50例,以随机数表法分为两组,每组25例,观察组(臂丛神经上干阻滞)和对照组(臂丛神经上中下三干阻滞)。对比两组患者麻醉相关指标,不同时刻生命体征,术后不同时刻屈肘、屈腕肌力。结果两组麻醉起效时间、苏醒时间及术后苏醒即刻与术后6 h的VAS评分比较,差异无统计学意义(P>0.05)。观察组神经阻滞操作时间(3.52±0.48)min明显短于对照组(6.82±0.92)min,差异有统计学意义(t=15.901,P<0.05)。观察组苏醒即刻、术后6 h的屈肘屈腕肌力明显高于对照组,差异有统计学意义(P<0.05)。结论 在肩关节镜手术中采用超声引导下肌间沟入路臂丛神经上干阻滞操作时间短,术中及术后镇痛效果确切,术中血流动力学指标稳定,且有利于患者术后上肢远端肌力恢复。

Objective To investigate the effect of ultrasound-guided superior trunk block of brachial plexus by intermuscular groove approach in shoulder arthroscopic surgery.Methods 50 patients who underwent shoulder arthroscopic surgery at Jianhu Clinical Medical College,Yangzhou University from July 2021 to June 2022 were selected and randomly divided into two groups,with 25 cases in each group.The observation group(upper trunk block of brachial plexus nerve) and the control group(upper,middle,and lower trunk block of brachial plexus nerve)were selected.Compared the anesthesia related indicators,vital signs at different times,and elbow and wrist flexion muscle strength at different postoperative times between two groups of patients.Results There was no statistically significant differencein the onset time,recovery time,and VAS scores between the two groups of anesthesia,as well as the immediate and 6-hour postoperative recovery(P<0.05).The nerve block operation time in the observation group(3.52±0.48) minutes was significantly shorter than that in the control group(6.82±0.92) minutes,the difference was statistically significant(t=15.901,P<0.05).The elbow and wrist flexion muscle strength of the observation group immediately after awakening and 6 hours after surgery was significantly higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion The use of ultrasound-guided intermuscular groove approach for upper trunk brachial plexus block in shoulder arthroscopic surgery has short operation time,accurate intraoperative and postoperative analgesia,stable intraoperative hemodynamic indexes,and is beneficial to postoperative recovery of distal upper limb muscle strength.