全身麻醉复合肌间沟臂丛神经阻滞在肩关节镜下巨大肩袖修复术中的应用效果

Efficiency of general anesthesia combined with interscalene brachial plexus block in the repair of giant rotator cuff under shoulder arthroscopy

  • 摘要: 目的 探讨全身麻醉复合肌间沟臂丛神经阻滞在肩关节镜下巨大肩袖修复术中的临床应用效果。 方法 选取择期行肩关节镜下巨大肩袖修复术的40例患者作为研究对象,按照随机数字表法分为实验组和对照组,各20例。实验组采用全身麻醉联合臂丛神经阻滞(0.4%罗哌卡因15 mL), 对照组采用单纯全身麻醉。比较2组患者手术入室、切皮、插管、拔管时刻的平均动脉压、心率、脑电双频指数(BIS)指标变化以及术中45、60、75、90 min时的心率与平均动脉压,并比较2组患者单位时间内阿片类药物消耗量、苏醒时间、满意度、焦虑程度、术后按压镇痛泵次数及术后30 min、6 h、24 h的视觉模拟评分法(VAS)评分等指标结果。 结果 实验组切皮时的心率、平均动脉压低于对照组,拔管时的BIS值高于对照组,差异有统计学意义(P<0.05); 实验组患者术中45、60、75、90 min时的心率、平均动脉压均低于对照组,差异有统计学意义(P<0.05); 实验组术后镇痛泵按压次数、苏醒时间、阿片类药物瑞芬太尼单位时间消耗量少于对照组,术后第1天焦虑程度低于对照组,差异有统计学意义(P<0.05); 2组患者满意度比较,差异无统计学意义(P>0.05); 实验组术后30 min时的VAS评分低于对照组,差异有统计学意义(P<0.05)。 结论 在肩关节镜下巨大肩袖修复术中采用全身麻醉复合肌间沟臂丛神经阻滞,可使患者围术期血流动力学更稳定,使手术视野更清晰,并减少全身麻醉药尤其是阿片类药物的用量,患者术后镇痛效果好。

     

    Abstract: Objective To explore efficiency of general anesthesia combined with interscalene brachial plexus block in the repair of giant rotator cuff under shoulder arthroscopy. Methods Forty patients with repair of giant rotator cuff by shoulder arthroscopy were selected and randomly divided into experimental group and control group, with 20 cases in each group. The experimental group was treated with general anesthesia combined with interscalene brachial plexus block(15 mL of 0.4% ropivacaine),while general anesthesia was performed alone in the control group. The changes of blood pressure, heart rate, bispectral index(BIS)at time points of entry, skin cutting, intubation and extubation, and heart rate and mean arterial pressure at 45, 60, 75 and 90 min during operation were compared between two groups. The opioid consumption, recovery time, satisfaction degree, anxiety degree, times of pressing analgesia pump and VAS scores at 30 min, 6 h and 24 h after operation were compared between the two groups. Results The heart rate and mean arterial pressure in the experimental group were significantly lower than those in the control group, and the BIS at the extubation was significantly higher than that in the control group(P<0.05). The heart rate and mean arterial pressure at 45, 60, 75 and 90 min during operation in the experimental group were significantly lower than those in the control group(P<0.05). In the experimental group, the times of pressing analgesia pump, the time to wake up and the consumption of remifentanil per unit time were significantly less than those in the control group, and the level of anxiety on the first day after operation was - significantly lower than that in the control group(P<0.05). There was no significant difference in satisfaction degree between two groups(P>0.05). The VAS score of experimental group at 30 minutes after operation was significantly lower than that of control group(P<0.05). Conclusion Application of general anesthesia combined with interscalene brachial plexus block in the repair of giant rotator cuff under shoulder arthroscopy can make the hemodynamics more stable during the perioperative period, make the operation field more clear, and reduce the dosage of general anesthetics, especially use of opioids. The patients have good postoperative analgesia effect.

     

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