【摘要】：目的： 探討神經(jīng)阻滯復(fù)合全麻與單純?nèi)橄啾�，�?duì)肩關(guān)節(jié)鏡下行肩袖修補(bǔ)術(shù)的患者術(shù)中管理及術(shù)后鎮(zhèn)痛效果的影響。 方法： 選擇ASA評(píng)級(jí)I～I(xiàn)I級(jí)的肩關(guān)節(jié)鏡手術(shù)的患者60例，按照隨機(jī)數(shù)字法分為單純?nèi)榻M（D組）和神經(jīng)阻滯復(fù)合全麻組（F組）。F組患者于全麻誘導(dǎo)前進(jìn)行超聲引導(dǎo)下肌間溝臂叢神經(jīng)阻滯加頸淺叢神經(jīng)阻滯。局麻藥物均采用0.5%的羅哌卡因，首先在患者前中斜角肌肌間溝頂點(diǎn)進(jìn)行臂叢神經(jīng)阻滯，觀察五分鐘無不良反應(yīng)后，于頸外靜脈與胸鎖乳突肌后緣中點(diǎn)交界處下0.5cm處進(jìn)行頸淺叢神經(jīng)阻滯。神經(jīng)阻滯完畢后進(jìn)行常規(guī)全麻誘導(dǎo)。D組患者入室監(jiān)護(hù)后直接進(jìn)行常規(guī)全麻誘導(dǎo)。兩組患者術(shù)中均以七氟醚維持麻醉深度，根據(jù)血壓、心率變化判斷追加芬太尼用量。記錄患者麻醉誘導(dǎo)前（T1）、手術(shù)開始后20min（T2）、手術(shù)結(jié)束時(shí)（T3）、拔管后10min（T4）幾個(gè)時(shí)間點(diǎn)的平均動(dòng)脈壓（MAP）、心率（BP）。采用視覺模擬評(píng)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】對(duì)患者術(shù)后2、6、12、24h疼痛程度進(jìn)行評(píng)分。記錄患者手術(shù)時(shí)間、麻醉時(shí)間以及術(shù)中芬太尼用量。記錄患者術(shù)后自控鎮(zhèn)痛泵按壓次數(shù)。對(duì)患者鎮(zhèn)痛滿意度進(jìn)行評(píng)分以及記錄麻醉相關(guān)不良反應(yīng)情況。 結(jié)果： 1.兩組患者術(shù)前MAP、RP無明顯差異（p0.05）手術(shù)時(shí)間，麻醉時(shí)間無明顯差異，無統(tǒng)計(jì)學(xué)意義（p0.05)2.術(shù)中及術(shù)后兩小時(shí)血流動(dòng)力學(xué)變化與D組相比，F(xiàn)組患者血流動(dòng)力學(xué)更平穩(wěn)，術(shù)中血壓及心率變化情況有明顯差異，，有統(tǒng)計(jì)學(xué)意義（p0.05)3.術(shù)中舒芬太尼用量以及術(shù)后鎮(zhèn)痛泵按壓次數(shù)，F(xiàn)組少于D組，有統(tǒng)計(jì)學(xué)意義（p0.05)4.視覺模擬評(píng)分(VAS)：F組低于D組,有統(tǒng)計(jì)學(xué)意義（p0.05) 結(jié)論： 超聲引導(dǎo)下的神經(jīng)阻滯復(fù)合全麻應(yīng)用于肩關(guān)節(jié)鏡手術(shù)中，不但能夠更好的維持術(shù)中血流動(dòng)力學(xué)的穩(wěn)定，還能夠減少麻醉藥用量，提高患者舒適度，更加有效持久鎮(zhèn)痛，有利于患者術(shù)后早期康復(fù)運(yùn)動(dòng)的進(jìn)行。與傳統(tǒng)的單純?nèi)橄啾�，在滿足手術(shù)需要的同時(shí)，延長(zhǎng)了鎮(zhèn)痛的時(shí)間，極大減輕了手術(shù)創(chuàng)傷給患者帶來的痛苦，值得推廣。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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