CAJ | 학술논문

目的观察连续肌间沟臂丛神经阻滞(CISB)复合全身麻醉(GA)对行肩关节镜手术的患者术中血流动力学控制、全身麻醉用药量、术野出血情况、术后镇痛、并发症等方面的影响.方法经北京大学第三医院伦理委员会批准,选择2010年11月至2011年10月于北京大学第三医院行择期单侧肩关节镜下肩袖修复术的患者60例.使用随机数字表将患者随机分为肌间沟臂丛神经阻滞复合全身麻醉组(ISB+ GA组)和全身麻醉组(GA组).ISB+ GA组患者首先接受ISB,两组患者均接受GA,术中实施控制性降压,维持外耳道水平平均动脉压(MAP)60～65 mm Hg(1 mm Hg=0.133 kPa),术后ISB+ GA组采用CISB镇痛,GA组使用静脉患者自控镇痛(PCIA).结果两组均能提供较好的手术视野,术野评分差异无统计学意义.维持期间ISB+ GA组较GA组瑞芬太尼用量低[(0.04±0.03)vs(0.14±0.03)μg·kg-1·min-1,P＜0.01],七氟烷吸入浓度亦低(1.80％±0.5％比2.1％±0.5％,P＜0.05).术中两组患者均能维持理想的目标血压,组间比较各时点MAP和心率差异无统计学意义;手术结束后各时点MAP和心率ISB+ GA组均低于GA组(P＜0.05).术后ISB+ GA组疼痛评分均低于GA组(P＜0.01),患者满意度高于GA组[8(6～10)比7(5 ～10),P＜0.01].结论与单纯GA比较,ISB复合GA能更好控制术中血压,减少术中全麻药用量,使患者苏醒更快,术后镇痛效果更好,并发症更少,患者满意度更高.在肩关节镜手术时采用ISB复合GA是更好的选择.
목적 관찰련속기간구비총신경조체(CISB)복합전신마취(GA)대행견관절경수술적환자술중혈류동역학공제、전신마취용약량、술야출혈정황、술후진통、병발증등방면적영향.방법 경북경대학제삼의원윤리위원회비준,선택2010년11월지2011년10월우북경대학제삼의원행택기단측견관절경하견수수복술적환자60례.사용수궤수자표장환자수궤분위기간구비총신경조체복합전신마취조(ISB+ GA조)화전신마취조(GA조).ISB+ GA조환자수선접수ISB,량조환자균접수GA,술중실시공제성강압,유지외이도수평평균동맥압(MAP)60～65 mm Hg(1 mm Hg=0.133 kPa),술후ISB+ GA조채용CISB진통,GA조사용정맥환자자공진통(PCIA).결과 량조균능제공교호적수술시야,술야평분차이무통계학의의.유지기간ISB+ GA조교GA조서분태니용량저[(0.04±0.03)vs(0.14±0.03)μg·kg-1·min-1,P＜0.01],칠불완흡입농도역저(1.80％±0.5％비2.1％±0.5％,P＜0.05).술중량조환자균능유지이상적목표혈압,조간비교각시점MAP화심솔차이무통계학의의;수술결속후각시점MAP화심솔ISB+ GA조균저우GA조(P＜0.05).술후ISB+ GA조동통평분균저우GA조(P＜0.01),환자만의도고우GA조[8(6～10)비7(5 ～10),P＜0.01].결론 여단순GA비교,ISB복합GA능경호공제술중혈압,감소술중전마약용량,사환자소성경쾌,술후진통효과경호,병발증경소,환자만의도경고.재견관절경수술시채용ISB복합GA시경호적선택.
Objective To compare continuous interscalene brachial plexus block (CISB) in the patients undergoing rotator cuff repair surgery.Methods A total of 60 patients undergoing rotator cuff repair surgery were randomly assigned to either ISB plus GA group (ISB + GA group) or GA group.Preoperatively,an interscalene catheter was placed in the ISB + GA group patients.Both groups received general anesthesia.The intraoperative mean arterial pressure (MAP) at the level of external acoustic meatus was maintained at a target of 60-65 mm Hg with a continuous infusion of remifentanil.Postoperatively,the patients in the ISB + GA and GA groups received CISB and patient controlled intravenous analgesia (PCIA) respectively for 48 h.Results Surgical field conditions were similar in two groups(P =1.000).Compared to the GA group,the consumption of remifentanil [(0.04±0.03)vs(0.14±0.03) μg · kg-1 · min-1,P＜0.01] and the inhalational concentration of sevoflurane(1.80％ ± 0.5％ vs 2.1％ ± 0.5％,P ＜ 0.05) were lower in the ISB + GA group.Compared to the GA group,the values of MAP and heart rate (HR) were lower at all postoperative time-points in the ISB + GA group(P ＜ 0.05).The postoperative measurements of numerical rating pain score (NRPS) were lower (P ＜ 0.01) and the level of patient satisfaction was greater in the ISB + GA group [8(6-10) vs 7 (5-10),P ＜ 0.01].Conclusion In comparisons with GA alone for rotator cuff repair surgery,the combined uses of ISB and GA may achieve a better perioperative control of hemodynamic responses,a markedly reduced consumption of general anesthetics,a rapid recovery of consciousness from anesthesia,superior analgesia with fewer side effects and greater patient satisfaction.