[1]吴赞情,张阿曼△,董补怀.选择性颈神经根阻滞与臂丛神经阻滞在肩关节镜术后镇痛效果的对比研究*[J].陕西医学杂志,2019,(5):639-643.
　WU Zanqing,ZHANG Aman,DONG Buhuai..Comparison of analgesic effect of selective cervical nerve root block and brachial plexus block in arthroscopic shoulder surgery[J].,2019,(5):639-643.
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选择性颈神经根阻滞与臂丛神经阻滞在肩关节镜术后镇痛效果的对比研究*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年5期
页码:
639-643
栏目:
临床研究
出版日期:
2019-05-05

文章信息/Info

Title:
Comparison of analgesic effect of selective cervical nerve root block and brachial plexus block in arthroscopic shoulder surgery
文章编号:
DOI: 10.3969/j.issn.10007377.2019.05.027
作者:
吴赞情1; 张阿曼2△; 董补怀
1.西安市红会医院麻醉科（西安 710054）;2.陕西中医药大学第二附属医院（咸阳 712000）
Author(s):
WU Zanqing;  ZHANG Aman;  DONG Buhuai.
Department of Anesthesiology, Xi’an Honghui Hospital ( Xi’an 710054 )
关键词:
肩关节镜术; 选择性颈神经根阻滞; 臂丛神经阻滞; 心率; 平均动脉压; MBS运动评分
Keywords:
Key words Arthroscopic shoulder surgery;  Selective cervical nerve root block;  Brachial plexus; heart rate; Average arterial pressure; MBS exercise scores 〖HJ1〗〖HJ〗
分类号:
R614.3
文献标志码:
A
摘要:
摘 要 目的：研究选择性颈神经根阻滞与臂丛神经阻滞在肩关节镜术后镇痛中的效果。方法：选取择期行肩关节镜手术全麻的患者84例，随机分为选择性颈神经根阻滞组（A组）、沟臂丛阻滞组（B组），每组各42例。A组在超声引导下定位C5、C6神经根，各给予0.5% 罗哌卡因5 ml，B组在超声引导下给予臂丛神经0.5%罗哌卡因10 ml。记录手术前、手术开始5 min、手术结束、拔管后10 min患者的心率及平均动脉压；记录术后4、12、24 h的前臂MBS运动评分，包括屈肘、屈腕、屈指；记录术后4、12、24 h的VAS评分；记录术后24 h曲马多用量，患者满意度以及患者发生不良反应的情况。结果：手术前，两组患者心率及平均动脉压无统计学差异（P＞0.05），手术开始5 min、手术结束、拔管后10 min，A组患者心率及平均动脉压显著低于B组（P＜0.05）。术后4、12 h，A组患者屈肘、屈腕、屈指MBS运动评分显著高于B组（P＜0.05），术后24 h，两组患者MBS运动评分差异无统计学意义（P＞0.05）；术后4、12、24 h，A组患者VAS评分均显著低于B组（P＜0.05）；术后24 h，A组患者曲马多用量及术后不良反应发生率均显著低于B组，患者满意度显著高于B组（均P＜0.05）。结论：在肩关节镜手术中，选择性颈神经根阻滞在术中及术后24 h内镇痛效果优于传统的臂丛神经阻滞，患者在短期内即可恢复屈肘、屈腕、屈指等前臂运动，使患者早日恢复锻炼，患者满意度高，且不良反应较少，临床应用价值较高。
Abstract:
Abstract Objective：To compare the analgesic effect of selective cervical nerve root block and brachial plexus block in arthroscopic shoulder surgery.Methods：84 patients with shoulder arthroscopic surgery under general anesthesia were randomly divided into selective cervical nerve root block group (group A) and brachial plexus block group (group B), each with 42 cases. In group A, C5 and C6 nerve roots were given 0.5% ropivacaine 5 ml respectively; Patients in group B were given 0.5% ropivacaine 10 ml under ultrasound guidance. The scores of forearm modified Bromage scale (MBS) including elbow, wrist and finger flexion and VAS were recorded at the post 4 h, 12 h and 24 h. Then the cumulative tramadol consumption, the patients' satisfaction rate and adverse effects were recorded.Results：The heart rate and mean arterial pressure between the two groups had no difference (P＞0.05), and were lower in the group A than in the group B at the intraoperative 5min, end of operation and pose- extubating 10 min (P＜0.05). At the postoperative 4 h and 12 h, the MBS exercise scores of the elbow flexion, wrist flexion, and flexion in the group A were significantly higher than those in the group B (P＜0.05), while no difference was found at the post 24 h (P＞0.05). At the postoperative 4 h, 12 h and 24 h, the VAS scores in group A were significantly lower than those in group B (P＜0.05). At the postoperative 24 h, the group A had lower cumulative tramadol consumption and adverse effects as well as higher the patients' satisfaction rate than those of the group B (P＜0.05). Conclusion: In arthroscopic shoulder surgery, selective cervical nerve root block is superior to traditional brachial plexus block in analgesic effect during operation and within 24 h after operation. Patients can recover forearm move〖LM〗ments such as elbow flexion, wrist flexion and finger flexion in a short period of time, enabling patients to resume exercise as soon as possible, with high patient satisfaction, less adverse reactions and high clinical application value.

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备注/Memo

备注/Memo:
*中国博士后基金面上资助项目（2016M590965）
更新日期/Last Update: 2019-05-07