| 周维德,杨歆璐,汪姗,等.超声引导下前路肩胛上神经阻滞对肩关节镜术后镇痛及呼吸功能的影响[J].中国临床保健杂志,2022,25(2):195-198. |
| 超声引导下前路肩胛上神经阻滞对肩关节镜术后镇痛及呼吸功能的影响 |
| Effect of ultrasound-guided anterior suprascapular block on postoperative analgesia and respiratory function in patients undergoing shoulder arthroscopic surgery |
| 投稿时间：2021-12-27 |
| DOI：10.3969/J.issn.1672-6790.2022.02.013 |
| 中文关键词: 关节成形术 肩关节 神经传导阻滞 臂丛 镇痛 呼吸生理学现象 |
| 英文关键词: Arthroplasty Shoulder joint Nerve block Brachial plexus Analgesia Respiratory physiological phenomena 〖FL |
| 基金项目:安徽省重点研究与开发计划项目(1804h08020286) |
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| 摘要点击次数: 1956 |
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| 中文摘要: |
| 目的 评估超声引导下前路肩胛上神经阻滞对肩关节镜手术患者术后镇痛及呼吸功能的影响。方法 选择择期行单侧肩关节镜下治疗的患者60例,男25例,女35例,年龄21~65岁,体重指数18~25 kg/m2,美国麻醉师协会(ASA)Ⅰ~Ⅱ级,采用随机数字表法分为前路肩胛上神经阻滞组(S组)和肌间沟臂丛神经阻滞组(I组),每组30例；患者分别在全身麻醉诱导前行超声引导下肩胛上神经阻滞和臂丛神经阻滞,注射0.375%罗哌卡因注射液15 mL。阻滞前及阻滞后30 min、拔管后30 min,分别用M型超声测量膈肌活动度,肺功能仪测量第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF),记录患者拔管后30 min、术后6、12、24 h的静息视觉模拟评分法(VAS)评分,术后12、24 h运动VAS评分,术后24 h PCIA泵首次按压时间、有效按压次数、实际按压次数、补救镇痛次数,并记录不良反应情况。结果 阻滞后30 min,I组膈肌麻痹率明显高于S组(P<0.05),FEV1、FVC、PEF明显降低(P<0.05),与阻滞后相比,拔管后30 min I组膈肌麻痹率降低；S组拔管后30 min VAS静息评分高于I组(P<0.05),但2组术后6、12、24 h静息VAS、运动VAS评分、PCIA泵首次按压时间、有效按压次数、实际按压次数及补救镇痛次数差异无统计学意义。结论 前路肩胛上神经阻滞可为肩关节镜患者提供满意的镇痛,且引起的膈神经阻滞更少,对呼吸功能的影响更小。 |
| 英文摘要: |
| Objective To investigate respiratory function and the effects of postoperative analgesia following ultrasound-guided anterior suprascapular block in patients undergoing shoulder arthroscopic surgery.Methods Sixty patients undergoing shoulder arthroscopic surgery were enrolled,25 male and 35 famales,aged 21-65 years,BMI 18-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomized into 2 groups (n=30 each):anterior superiortrunk block group (group S) or an interscalene block group (group Ⅰ).Patients either received a anterior superiortrunk block or an interscalene block with 15 mL of 0.375% ropivacaine.PCIA was preformed in both groups after surgery.The hemidia phragmatic movement was measured by M-mode ultrasonography under deep breathing test before the block procedure,30 min after the block and 30 min after extubation.The pulmonary function tests including forced expiratory volume in one second (FEV1),forced vital capacity (FVC),peak expiratory flow (PEF) were performed before and 30 min after the block.Each patient was assessed the pulmonary function tests 30 min after extubation.The VAS scores at 30 min after extubation and 6 h,12 h,24 h after surgery,time to first analgesic request,the number and attempts of PCIA the rescue analgesic,other complications were recorded.Results There was a statistically significant difference in both the degree of diaphragm paralysis and pulmonary function indicator between the two groups under deep breathing test 30 min after the block.Compared with group I,the rate of hemi diaphragmatic paralysis in group S was lower,FEV1,FVC and PEF were significant higher (P<0.05).Compared with that after block,the diaphragm paralysis rate decreased in group I at 30 min after extubation.The rest VAS scores at 30 min after extubation was higher in group S,however,there exit no differences of VAS scores at other times between the two groups.Time to first analgesic request and the rescue analgesic difference were not statistically significant.Conclusions The anterior suprascapular block can provid effective analgesia compared with interscalene brachial plexus block after arthroscopic shoulder surgery and resulte in significantly less hemidiaphragmatic paresis and respiratory function. |
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