超声引导下神经阻滞复合全麻在肩关节镜手术中的应用

发布时间：2018-07-26 07:57

【摘要】：目的：探讨神经阻滞复合全麻与单纯全麻相比，对肩关节镜下行肩袖修补术的患者术中管理及术后镇痛效果的影响。方法：选择ASA评级I～II级的肩关节镜手术的患者60例，按照随机数字法分为单纯全麻组（D组）和神经阻滞复合全麻组（F组）。F组患者于全麻诱导前进行超声引导下肌间沟臂丛神经阻滞加颈浅丛神经阻滞。局麻药物均采用0.5%的罗哌卡因，首先在患者前中斜角肌肌间沟顶点进行臂丛神经阻滞，观察五分钟无不良反应后，于颈外静脉与胸锁乳突肌后缘中点交界处下0.5cm处进行颈浅丛神经阻滞。神经阻滞完毕后进行常规全麻诱导。D组患者入室监护后直接进行常规全麻诱导。两组患者术中均以七氟醚维持麻醉深度，根据血压、心率变化判断追加芬太尼用量。记录患者麻醉诱导前（T1）、手术开始后20min（T2）、手术结束时（T3）、拔管后10min（T4）几个时间点的平均动脉压（MAP）、心率（BP）。采用视觉模拟评分（visual analogue Scale,VAS)【Cole B,Finch E,Gowland C,et al. VisualAnalogue Scale.In:Physical Rehabilitation Outcome Measures[M].Canada Communication Group Publishing,1994.80】对患者术后2、6、12、24h疼痛程度进行评分。记录患者手术时间、麻醉时间以及术中芬太尼用量。记录患者术后自控镇痛泵按压次数。对患者镇痛满意度进行评分以及记录麻醉相关不良反应情况。结果： 1.两组患者术前MAP、RP无明显差异（p0.05）手术时间，麻醉时间无明显差异，无统计学意义（p0.05)2.术中及术后两小时血流动力学变化与D组相比，F组患者血流动力学更平稳，术中血压及心率变化情况有明显差异，，有统计学意义（p0.05)3.术中舒芬太尼用量以及术后镇痛泵按压次数，F组少于D组，有统计学意义（p0.05)4.视觉模拟评分(VAS)：F组低于D组,有统计学意义（p0.05) 结论：超声引导下的神经阻滞复合全麻应用于肩关节镜手术中，不但能够更好的维持术中血流动力学的稳定，还能够减少麻醉药用量，提高患者舒适度，更加有效持久镇痛，有利于患者术后早期康复运动的进行。与传统的单纯全麻相比，在满足手术需要的同时，延长了镇痛的时间，极大减轻了手术创伤给患者带来的痛苦，值得推广。
[Abstract]:Objective: to investigate the effect of nerve block combined with general anesthesia on the management and analgesic effect of shoulder arthroscopic rotator cuff repair. Methods: sixty patients with ASA I~II grade shoulder arthroscopy were selected. According to the random number method, the patients were divided into simple general anesthesia group (group D) and nerve block combined with general anesthesia group (group F). Patients in group F were treated with ultrasound guided intermuscular sulcus brachial plexus block plus superficial cervical plexus block before general anesthesia induction. The local anesthetics were treated with 0.5% ropivacaine. Brachial plexus nerve block was performed at the apex of the anterior and middle scalene muscle sulcus, and no adverse reactions were observed for five minutes. The superficial cervical plexus nerve block was performed at the junction of the external jugular vein and the posterior edge of sternocleidomastoid muscle. After nerve block, the patients in group D were induced by general anesthesia. The anesthetic depth was maintained by sevoflurane in both groups, and the dosage of fentanyl was evaluated according to the changes of blood pressure and heart rate. The mean arterial pressure (MAP),) heart rate (BP).) was recorded before anesthesia induction (T1), 20min (T2) after operation, at the end of operation (T3) and 10min (T4) after extubation. Visual analogue score (visual analogue scale VAS) was used. VisualAnalogue Scale.In:Physical Rehabilitation Outcome Measures [M] .Canada Communication Group Publishing 1994.80 was used to evaluate the pain level in 24 hours after operation. Time of operation, time of anesthesia and dosage of fentanyl during operation were recorded. The times of patient controlled analgesia pump pressing were recorded. Patients were evaluated for analgesic satisfaction and anaesthesis-related adverse reactions were recorded. Results: 1. There was no significant difference (p0.05) in preoperative MAPRP and no significant difference in anesthesia time between the two groups (p0.05). Hemodynamic changes were more stable in group F than those in group D, and there were significant differences in blood pressure and heart rate during operation (p0.05) (p0.05). The dosage of sufentanil during operation and the times of postoperative analgesic pump pressing were significantly lower in group F than in group D (p0.05). The visual analogue score of group (VAS): F was lower than that of group D (p0.05). Conclusion: the nerve block combined with general anesthesia under the guidance of ultrasound was used in shoulder arthroscopic surgery. It can not only maintain the stability of hemodynamics during operation, but also reduce the dosage of anesthetic, improve the comfort of patients, and be more effective and lasting analgesia, which is beneficial to the early rehabilitation of patients after operation. Compared with the traditional general anesthesia, the analgesia time is prolonged and the pain caused by surgical trauma is greatly alleviated, which is worth popularizing.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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