国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
3期
230-233,252
,共5页
李露%李秋军%周海滨%杨庆国
李露%李鞦軍%週海濱%楊慶國
리로%리추군%주해빈%양경국
肩关节镜术%臂丛神经阻滞%全身麻醉%麻醉质量
肩關節鏡術%臂叢神經阻滯%全身痳醉%痳醉質量
견관절경술%비총신경조체%전신마취%마취질량
Shoulder arthroscopy%Brachial plexus nerve block%General anesthesia%Anesthesia quality
目的 探讨臂丛神经阻滞复合全身麻醉在肩关节镜术中的应用. 方法 择期在侧卧位下行肩关节镜手术的患者44例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄35岁～65岁,体重50 kg～90 kg,按随机数字表法随机分为A、B两组(每组22例),均行静吸复合全身麻醉,B组全身麻醉前在超声引导下用0.2％罗哌卡因20 ml行肌间沟神经阻滞.记录患者入室、切皮前、切皮、术中30、60、90 min时、拔管后30 min时的心率(HR)、有创收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP);术中舒芬太尼、罗库溴铵、艾司洛尔、硝酸异山梨酯的应用情况；手术前后的动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)；呼吸恢复时间、拔管时间、苏醒时间以及恢复阶段的疼痛视觉模拟评分(visual analog scale,VAS)、镇痛药应用情况及并发症. 结果 A组和B组患者切皮时HR、MAP、七氟醚和舒芬太尼用量分别为(68±11)次/ min和(63±7)次/min、(86±15) mmHg和(69±10) mmHg(1 mmHg=0.133 kPa)、(1.28±0.21)最低肺泡有效浓度(minimum alveolar concentration,MAC)和(1.08-0.20) MAC、(0.54±0.08) μg/kg和(0.34±0.06) μg/kg(P＜0.001).A组和B组需要血管活性药物的例数、拔管时间、术后PaCO2分别为12例和2例、(13±10) min和(7±4) min、(44±3) mm Hg和(42±3)mm Hg(P＜0.05).A组和B组在恢复阶段的疼痛VAS分别为(4±2)和(0±2)(P＜0.001).两组间相关并发症的差异无统计学意义(P＞0.05). 结论 臂丛神经阻滞复合全身麻醉能提高肩关节术中的麻醉质量,减少术中血压波动、麻醉性镇痛药和短效降压药的应用,缩短拔管时间,有短时术后镇痛效果,无严重并发症.
目的 探討臂叢神經阻滯複閤全身痳醉在肩關節鏡術中的應用. 方法 擇期在側臥位下行肩關節鏡手術的患者44例,美國痳醉醫師協會(ASA)分級Ⅰ或Ⅱ級,年齡35歲～65歲,體重50 kg～90 kg,按隨機數字錶法隨機分為A、B兩組(每組22例),均行靜吸複閤全身痳醉,B組全身痳醉前在超聲引導下用0.2％囉哌卡因20 ml行肌間溝神經阻滯.記錄患者入室、切皮前、切皮、術中30、60、90 min時、拔管後30 min時的心率(HR)、有創收縮壓(SBP)、舒張壓(DBP)和平均動脈壓(MAP);術中舒芬太尼、囉庫溴銨、艾司洛爾、硝痠異山梨酯的應用情況；手術前後的動脈血氧飽和度(SaO2)、動脈血氧分壓(PaO2)和動脈血二氧化碳分壓(PaCO2)；呼吸恢複時間、拔管時間、囌醒時間以及恢複階段的疼痛視覺模擬評分(visual analog scale,VAS)、鎮痛藥應用情況及併髮癥. 結果 A組和B組患者切皮時HR、MAP、七氟醚和舒芬太尼用量分彆為(68±11)次/ min和(63±7)次/min、(86±15) mmHg和(69±10) mmHg(1 mmHg=0.133 kPa)、(1.28±0.21)最低肺泡有效濃度(minimum alveolar concentration,MAC)和(1.08-0.20) MAC、(0.54±0.08) μg/kg和(0.34±0.06) μg/kg(P＜0.001).A組和B組需要血管活性藥物的例數、拔管時間、術後PaCO2分彆為12例和2例、(13±10) min和(7±4) min、(44±3) mm Hg和(42±3)mm Hg(P＜0.05).A組和B組在恢複階段的疼痛VAS分彆為(4±2)和(0±2)(P＜0.001).兩組間相關併髮癥的差異無統計學意義(P＞0.05). 結論 臂叢神經阻滯複閤全身痳醉能提高肩關節術中的痳醉質量,減少術中血壓波動、痳醉性鎮痛藥和短效降壓藥的應用,縮短拔管時間,有短時術後鎮痛效果,無嚴重併髮癥.
목적 탐토비총신경조체복합전신마취재견관절경술중적응용. 방법 택기재측와위하행견관절경수술적환자44례,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,년령35세～65세,체중50 kg～90 kg,안수궤수자표법수궤분위A、B량조(매조22례),균행정흡복합전신마취,B조전신마취전재초성인도하용0.2％라고잡인20 ml행기간구신경조체.기록환자입실、절피전、절피、술중30、60、90 min시、발관후30 min시적심솔(HR)、유창수축압(SBP)、서장압(DBP)화평균동맥압(MAP);술중서분태니、라고추안、애사락이、초산이산리지적응용정황；수술전후적동맥혈양포화도(SaO2)、동맥혈양분압(PaO2)화동맥혈이양화탄분압(PaCO2)；호흡회복시간、발관시간、소성시간이급회복계단적동통시각모의평분(visual analog scale,VAS)、진통약응용정황급병발증. 결과 A조화B조환자절피시HR、MAP、칠불미화서분태니용량분별위(68±11)차/ min화(63±7)차/min、(86±15) mmHg화(69±10) mmHg(1 mmHg=0.133 kPa)、(1.28±0.21)최저폐포유효농도(minimum alveolar concentration,MAC)화(1.08-0.20) MAC、(0.54±0.08) μg/kg화(0.34±0.06) μg/kg(P＜0.001).A조화B조수요혈관활성약물적례수、발관시간、술후PaCO2분별위12례화2례、(13±10) min화(7±4) min、(44±3) mm Hg화(42±3)mm Hg(P＜0.05).A조화B조재회복계단적동통VAS분별위(4±2)화(0±2)(P＜0.001).량조간상관병발증적차이무통계학의의(P＞0.05). 결론 비총신경조체복합전신마취능제고견관절술중적마취질량,감소술중혈압파동、마취성진통약화단효강압약적응용,축단발관시간,유단시술후진통효과,무엄중병발증.
Objective To evaluate the efficacy of anesthesia with general anesthesia combined with brachial plexus block in shoulder arthroscopy.Methods Forty-four patients (ASA Ⅰ or Ⅱ,aged 35 y-65 y,undergoing shoulder arthroscopy) were randomized into group A and B (n=22,each).While both groups having received inhalation-intravenous general anesthesia (GA),group B also received ultrasound-guided interscalene brachial plexus block with 0.2％ ropivacaine 20 ml before GA.The HR,SBP,DBP and MAP at entering operation room,before skin incision,at skin incision,30,60,90 min after skin incision,and 30 min after tracheal extubation,the use of sufentanyl,rocuronium,isosorbide dinitrate and esmolol,and SaO2,PaO2 and PaCO2 before and after surgery,and the spontaneous respiration regaining time,tracheal extubation time and fully consciousness regaining time,and the visual analog scale (VAS) of pain,analgesics application and complications in the PACU were recorded.Results The HR and MAP at skin incision,and the minimum alveolar concentration (MAC) of sevoflurane and dosage per weight of sufentanyl in group A and B were (68±11) bpm and (63±7) bpm,(86±15) mm Hg and (69±10) mm Hg(1 mm Hg=0.133 kPa),(1.28±0.21) MAC and (1.08±0.20) MAC,(0.54±0.08) μg/kg and(0.34±0.06) μg/kg,respectively(P＜0.001).The cases that needed esmolol or isosorbide dinitrate,the post-operation PaCO2 and the tracheal extubation time in group A and B were 12 and 2 cases,(13±10) min and (7±4)min,(44±3) mm Hg and (42±3) mm Hg,respectively (P＜0.05).The pain VAS of group A and B were (4±2) and (0±2),respectively (P＜0.001).There were no significant statistic differences between the two groups in relevant complications (P＞0.05).Conclusions Brachial plexus block combined with general anesthesia enhances the anesthesia quality in shoulder arthroscopy,which not only reduces the fluctuation of blood pressure,decreases the use of narcotic analgesics and short-acting antihypertensive agents,but also shortens the tracheal extubation time,and has short-time postoperative analgesic effect and no severe complications.
