臂丛神经阻滞对行肩关节镜手术患者应激反应的影响

Effect of brachial plexus block on stress response in patients undergoing shoulder arthroscopic surgery

目的 探究臂丛神经阻滞对行肩关节镜手术患者应激反应的影响。方法 选取复旦大学附属上海市第五人民医院2021年12月至2022年12月150例行肩关节镜手术的肩关节炎患者作为研究对象,按照随机数字表法分为对照组和观察组,每组75例。对照组患者采用全身麻醉,观察组患者在对照组基础上采用臂丛神经阻滞。比较2组患者术前(T0)、手术10 min(T1)、手术30 min(T2)、手术结束时(T3)、拔管30 min后(T4)的平均动脉压(MAP)、心率(HR)、去甲肾上腺素(NE)、皮质醇(Cor);比较2组患者术前和术后3 d的转化生长因子-β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP);比较2组患者术后清醒时与术后6、12、24 h的视觉模拟量表(VAS)评分。结果 与T0时相比,观察组和对照组患者T1、T2、T3、T4时的MAP、HR水平均显著降低(P<0.01),NE、Cor水平均显著升高(P<0.01),且观察组患者T1、T2、T3、T4时的MAP、HR、NE、Cor水平均显著低于对照组(P<0.01);观察组和对照组患者术后3 d TGF-β1、TNF-α、CRP水平均较术前显著升高(P<0.01),但观察组患者术后上述指标显著低于对照组(P<0.01);观察组患者术后清醒时与术后6、12、24 h的VAS评分均显著低于对照组(P<0.01)。结论 超声引导下肌间沟入路臂丛神经阻滞可以确保行肩关节镜手术中肩关节炎患者的生命体征稳定,减轻疼痛,减少应激,降低炎症反应。

Objective To investigate the effect of brachial plexus block on stress response in patients who underwent shoulder arthroscopic surgery.Methods A total of 150 patients with shoulder arthritis who underwent shoulder arthroscopic surgery in the Shanghai Fifth People's Hospital,Fudan University from December 2021 to December 2022 were selected as the study subjects.All patients were divided into the control group and the observation group by random number table method,with 75 cases in each group.Patients in the control group were given general anesthesia,while patients in the observation group were given brachial plexus block on the basis of the control group.The mean arterial pressure(MAP),heart rate(HR),norepinephrine(NE),cortisol(Cor)before operation(T0),10 minutes after operation(T1),30 minutes after operation(T2),at the end of operation(T3)and 30 minutes after extubation(T4)of the two groups were compared.The transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)before and 3 days after operation of the two groups were compared.The visual analogue scale(VAS)scores at postoperative wakefulness and 6,12 and 24 hours after operation of the two groups were compared.Results Compared with T0,the levels of MAP and HR at T1,T2,T3,and T4 in the observation group and the control group were obviously decreased(P<0.01),the levels of NE and Cor were obviously increased(P<0.01),while the levels of MAP,HR,NE,and Cor at T1,T2,T3,and T4 in the observation group were obviously lower than those in the control group(P<0.01).The levels of TGF-β1,TNF-α,and CRP 3 days after operation in the observation group and the control group were obviously increased compared with those before operation(P<0.01),and the above indicators after operation in the observation group were obviously lower than those in the control group(P<0.01).The VAS scores at postoperative wakefulness and 6,12 and 24 hours after operation in the observation group were obviously lower than those in the control group(P<0.01).Conclusion Ultrasound-guided brachial plexus block by interscalene approach can ensure the stability of the vital signs of patients with shoulder arthritis during shoulder arthroscopic surgery,alleviate pain,reduce stress,and reduce inflammatory response.