超声引导下星状神经节阻滞联合全麻对肩袖损伤关节镜手术患者血流动力学、疼痛程度的影响

Effects of ultrasound guided stellate ganglion block combined with general anesthesia on hemodynamics and pain in patients with rotator cuff injury undergoing arthroscopic surgery

目的探讨超声引导下星状神经节阻滞联合全麻对肩袖损伤关节镜手术患者血流动力学、疼痛程度的影响。方法纳入濮阳市油田总医院2019年1月—2021年12月收治的拟行关节镜手术的肩袖损伤患者68例,根据采取的麻醉方案不同,分为全麻组(n=34)和星状神经节阻滞组(n=34)。全麻组在关节镜手术中采用全身麻醉;星状神经节阻滞组在关节镜手术中超声引导下进行星状神经节阻滞联合全身麻醉。比较术中不同时间点血流动力学指标,术后不同时间点疼痛程度,术后麻醉恢复情况及不良反应发生率。结果T1、T2、T3、T4时间点,星状神经节阻滞组MAP和心率波动小于全麻组(P<0.05);术后4 h、12 h、24 h,星状神经节阻滞组VAS评分均低于全麻组(P<0.05);星状神经节阻滞组术后的拔管时间和术后苏醒时间均短于全麻组(P<0.05);星状神经节阻滞组不良反应发生率(8.82%)低于全麻组(29.41%)(P<0.05)。结论超声引导下星状神经节阻滞联合全麻用于肩袖损伤关节镜手术中,可较好地稳定术中血流动力学指标,减轻术后疼痛程度,减少并发症的发生,有助于术后早期拔管和快速苏醒,可早期接受肩关节功能康复训练,促进患者早日康复。

Objective To investigate the effects of ultrasound guided stellate ganglion block combined with general anesthesia on hemodynamics and pain in patients with rotator cuff injury undergoing arthroscopic surgery.Methods Totally 68 patients with rotator cuff injury who were admitted to our hospital from January 2019 to December 2021 for arthroscopic surgery were divided into general anesthesia group(n=34)and stellate ganglion block group(n=34)according to different point anesthesia schemes.The general anesthesia group was given general anesthesia during arthroscopic surgery;the stellate ganglion block group was given ultrasound guided stellate ganglion block combined with general anesthesia during arthroscopic surgery.The hemodynamic indexes at different time points during the operation,the degree of pain at different time points after the operation,the recovery of anesthesia after the operation and the incidence of adverse reactions were compared between two group.Results At T1,T2,T3,T4 time points,MAP and heart rate fluctuations in the stellate ganglion block group were lower than those of the general anesthesia group(P<0.05);at 4 h,12 h and 24 h after operation,the VAS score in the stellate ganglion block group was lower than that of the general anesthesia group(P<0.05);the time of decannulation and wake up after operation in the stellate ganglion block group were shorter than those of the general anesthesia group(P<0.05);the incidence of adverse reactions in stellate ganglion block group(29.41%)was lower than that in general anesthesia group(8.82%)(P<0.05).Conclusion The application of ultrasound guided stellate ganglion block combined with general anesthesia in arthroscopic surgery for rotator cuff injury can better stabilize intraoperative hemodynamic indicators,reduce postoperative pain,reduce the occurrence of complications,contribute to early extubation and rapid recovery after surgery,and can receive early shoulder function rehabilitation training to promote early recovery of patients.