文章摘要
宋峰,徐粤新,马姗姗,杜晓宣.超声引导下选择性神经阻滞在肩关节镜术后镇痛的临床应用.骨科,2019,10(5):452-456
超声引导下选择性神经阻滞在肩关节镜术后镇痛的临床应用
Clinical application of ultrasound-guided selective nerve block in postoperative analgesia after shoulder arthroscopy
投稿时间:2019-04-04  
DOI:10.3969/j.issn.1674-8573.2019.05.016
中文关键词: 超声引导  颈5神经根  锁骨上神经  神经阻滞
英文关键词: Ultrasound guidance  Cervical 5th nerve roots  Nerve supraclaviculares  Nerve blocking
基金项目:
作者单位E-mail
宋峰 新疆医科大学第六附属医院麻醉科乌鲁木齐 830002  
徐粤新 新疆医科大学第六附属医院麻醉科乌鲁木齐 830002  
马姗姗 新疆医科大学第六附属医院麻醉科乌鲁木齐 830002  
杜晓宣 新疆医科大学第六附属医院麻醉科乌鲁木齐 830002 duxiaoxuan730201@qq.com 
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中文摘要:
      目的 对比研究超声引导下C5神经根联合锁骨上神经阻滞与肌间沟臂丛神经阻滞在肩关节镜手术后镇痛的临床应用价值。方法 采用前瞻性随机对照研究,将我院2017年3月至2018年12月收治的60例进行单侧肩关节镜手术的病人纳入研究。按照随机数字表法分为观察组(超声引导选择性C5神经根联合锁骨上神经阻滞)和对照组(超声引导下肌间沟臂丛神经阻滞)。两组均在超声引导下完成神经阻滞后实施全身麻醉,均采取相同的全身麻醉药物诱导及维持。记录并比较两组病人术后3、6、9、12 h静息疼痛视觉模拟量表(visual analogue scale, VAS)评分,屈肘、屈腕肌力评分,术后30 min膈肌麻痹程度、霍纳综合征的发生率及病人满意度等指标。结果 两组静息VAS评分在各时间点的差异均无统计学意义(P均>0.05)。与对照组比较,观察组膈肌麻痹程度显著降低(P<0.05),屈肘、屈腕肌力显著增高(P<0.05),霍纳综合征的发生率显著降低(P<0.05),病人满意度显著增高(P<0.05)。结论 在肩关节镜手术中,肌间沟臂丛神经阻滞和选择性C5神经根联合锁骨上神经阻滞均能有效缓解术后疼痛,但选择性神经阻滞对病人的膈肌麻痹程度、屈肘及屈腕肌力影响小,能显著降低霍纳综合征的发生率,更有利于病人术后功能锻炼,达到早日康复的目的。
英文摘要:
      Objective To compare ultrasound-guided selective cervical 5th nerve root combined supraclavicular nerve block with interscalene brachial plexus block for postoperative analgesia after shoulder arthroscopy. Methods A total of 60 patients with unilateral shoulder arthroscopy were enrolled from March 2017 to December 2018 in our hospital. The subjects were randomly assigned to either ultrasound guided selective cervical 5th nerve root combined supraclavicular nerve block (experimental group) or ultrasound guided interscalene brachial plexus block (control group). Both groups received general anesthesia under ultrasound-guided nerve block, and the same general anesthetics were used for induction and maintenance. Visual analogue scale (VAS) score, elbow flexion and wrist flexion strength score at 3rd, 6th, 9th and 12th h after operation, degree of diaphragmatic paralysis, incidence of Horner syndrome and patient satisfaction were recorded and compared between the two groups. Results There was no significant difference in resting VAS score between the two groups at different time points (P>0.05). As compared with the control group, the degree of diaphragm paralysis in the observation group decreased significantly (P<0.05), elbow flexion and wrist flexion muscle strength increased significantly (P<0.05), the incidence of Horner syndrome decreased significantly (P<0.05), and patient satisfaction increased significantly (P<0.05). Conclusion Interscalene brachial plexus block and ultrasound guided selective cervical 5th nerve root combined supraclavicular nerve block can effectively alleviate postoperative pain in shoulder arthroscopic surgery, but selective nerve block has little effect on the degree of diaphragm paralysis, elbow flexion and wrist flexion strength of patients, can significantly reduce the incidence of Horner syndrome, and is more conducive to patients after surgery. Functional exercise can achieve the goal of early recovery.
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