右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉在肩关节镜手术中的应用效果观察

Application effect observation of dexmedetomidine combined with interscalene brachial plexus and suprascapular nerve block anesthesia during shoulder arthroscopic surgery

目的观察右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉在肩关节镜手术中的应用效果。方法纳入2023年1月~2024年1月收治的120例肩关节镜手术患者,按随机数表法分为联合组(n=60)、参照组(n=60)。联合组给予右美托咪定联合肌间沟臂丛和肩胛上神经阻滞麻醉,参照组给予肌间沟臂丛和肩胛上神经阻滞麻醉。比较患者不同时间点的镇痛效果[采用疼痛视觉模拟评分(VAS)]、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))、最大肺活量(VC_(max))、用力肺活量(FVC)及第1秒用力呼气容积(FEV_(1)/FVC)差异;记录患者不良反应。结果在手术结束时、术后30 min及6 h时,组间VAS评分差异无统计学意义(P>0.05),术后12 h、24 h、48 h时,联合组VAS评分显著低于参照组(P<0.05);诱导后10 min、30 min及手术结束时,两组患者MAP、HR、SpO_(2)水平均较术前降低,且联合组高于参照组(P<0.05);术后24 h时,两组患者VC_(max)、FVC、FEV_(1)/FVC水平均低于术前,且联合组高于参照组(P<0.05);联合组不良反应发生率显著低于参照组(P<0.05)。结论在肩关节镜手术的患者中,在肌间沟臂丛和肩胛上神经阻滞的基础上联合右美托咪定能够延长术后镇痛时间,减少侵入性操作引起的疼痛,降低不良反应发生率,且具有肺功能保护作用。

Objective To observe the application effect of dexmedetomidine combined with interscalene brachial plexus and suprascapular nerve block anesthesia during shoulder arthroscopic surgery.Methods 120 patients who received shoulder arthroscopic surgery from January 2023 to January 2024 were enrolled in the study,and were divided into the combined group(n=60)and the reference group(n=60)by adopting the random number table method.The combined group was given dexmedetomidine combined with interscalene brachial plexus and suprascapular nerve block anesthesia,while the reference group received interscalene brachial plexus and suprascapular nerve block anesthesia.The surgeryrelated indicators were recorded,and the analgesic effect VAS,MAP,HR,SpO_(2),VC_(max),FVC and FEV_(1)/FVC were compared at different time points.Adverse reactions of patients were recorded.Results At the end of surgery and at 30 min and 6 h after surgery,there was no statistical significance in VAS score between groups(P>0.05).At 12 h,24 h and 48 h after surgery,VAS score was significantly lower in combined group than that in reference group(P<0.05).At 10 min and 30 min after induction and at the end of surgery,the MAP,HR and SpO_(2)in both groups were lower than those before surgery,and the combined group had higher MAP,HR and SpO_(2)(P<0.05).The VC_(max),FVC and FEV_(1)/FVC in both groups at 24 h after surgery were lower than those before surgery,and the indicators in the combined group were higher than those in the reference group(P<0.05).The incidence rates of adverse reactions in combined group were significantly lower than those in reference group(P<0.05).Conclusion For patients undergoing shoulder arthroscopic surgery,interscalene brachial plexus and suprascapular nerve block combined with dexmedetomidine can prolong postoperative analgesic time,reduce pain caused by invasive procedures,and lower the incidence rates of adverse reactions,and it has a protective effect on lung function.