超声引导后路肌间沟臂丛神经阻滞麻醉复合全麻在肩关节镜手术中的应用

Application of Ultrasound-guided Posterior Intermuscular Groove Brachial Plexus Block Anesthesia Combined with General Anesthesia in Shoulder Arthroscopic Surgery

目的:探讨在肩关节镜手术中,超声引导后路肌间沟臂丛神经阻滞麻醉复合全麻的应用效果。方法:按照随机信封法对厦门市第五医院2021年4月—2023年5月收治的84例肩关节镜手术患者进行分组,对照组(38例)采用全身麻醉,研究组(46例)联用超声引导后路肌间沟臂丛神经阻滞麻醉,对比两组麻醉效果及围手术期相关指标。结果:两组术后1 h视觉模拟评分法(VAS)评分、术前心率和收缩压,以及去甲肾上腺素(NE)、皮质醇(Cor)水平比较,差异均无统计学意义(P>0.05),研究组术后12 h和术后24 h的VAS评分和术后24 h的NE、Cor水平均低于对照组,术后12 h,两组心率和收缩压均下降,但研究组均高于对照组,术后24 h两组心率和收缩压均上升,且研究组均高于对照组,差异均有统计学意义(P<0.05)。术后12 h,研究组苏醒质量评分高于对照组,术后48 h,研究组满意度评分高于对照组,研究组麻醉起效时间和苏醒时间均早于对照组,不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。结论:在肩关节镜手术中,超声引导后路肌间沟臂丛神经阻滞麻醉复合全麻能够促使患者心率和收缩压等血流动力学稳定,减轻术后疼痛,缓解氧化应激刺激,提高苏醒质量,加快预后康复,并降低不良反应发生风险,麻醉实用性和安全性更高。

Objective:To investigate the application effect of ultrasound-guided posterior intermuscular groove brachial plexus block anesthesia combined with general anesthesia in shoulder arthroscopic surgery.Method:A total of 84 patients with shoulder arthroscopic surgery admitted to Xiamen Fifth Hospital from April 2021 to May 2023 were divided into groups according to random envelope method.The control group(38 cases)received general anesthesia,and the study group(46 cases)combined with ultrasound-guided posterior intermuscular groove brachial plexus block anesthesia.The anesthetic effects and perioperative related indexes of the two groups were compared.Result:VAS score at 1 h after surgery,heart rate,systolic blood pressure,norepinephrine(NE)and cortisol(Cor)levels at preoperative were not significantly different between the two groups(P>0.05).VAS scores at 12 h and 24 h after surgery,NE and Cor levels at 24 h after surgery in the study group were lower than those in the control group;at 12 hours after operation,the heart rate and systolic blood pressure of the two groups decreased,but those in the study group were higher than those in the control group;at 24 hours after operation,the heart rate and systolic blood pressure of the two groups increased,and those in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).12 h after surgery,the recovery quality score of the study group was higher than that of the control group,and the satisfaction score of the study group was higher than that of the control group 48 hours after surgery;the onset time of anesthesia and recovery time of the study group were earlier than those of the control group,and the incidence of adverse reactions was lower than that of the control group,the differences were statistically significant(P<0.05).Conclusion:In shoulder arthroscopic surgery,ultrasound-guided posterior intermuscular brachial plexus block anesthesia combined with general anesthesia can promote the hemodynamic stability of patients'heart rate and systolic blood pressure,alleviate postoperative pain,relieve oxidative stress stimulation,improve the quality of recovery,accelerate the prognosis and reduce the risk of adverse reactions,and have higher anesthesia practicability and safety.