标题：超声引导下选择性颈神经根阻滞联合全麻对肩袖损伤肩关节镜手术患者血流动力学及术后镇痛效果的影响

      作者：赵丽，黄宏艳，金婷    深圳市盐田区人民医院麻醉科，广东 深圳 518081

      卷次： 2020年31卷4期

      【摘要】 目的 研究超声引导下选择性颈神经根阻滞联合全麻对肩袖损伤肩关节镜手术患者血流动力学及术后镇痛效果的影响。方法 回顾性分析 2017年 3月至 2019年 3月于深圳市盐田区人民医院实施肩关节镜手术的 150例肩袖损伤患者的诊疗及麻醉资料，按照麻醉方式的不同分为NA组与GA组各 75例。GA组实施常规全麻，NA组实施超声引导下选择性颈神经根阻滞联合全麻。比较两组患者术后 24 h的血流动力学指标、术后第一次进食饮水时间、下床活动时间、住院时间，疼痛状况及术后不良反应的发生情况。结果 NA组和GA组患者术后 24 h的舒张压、收缩压、心率以及平均动脉压最低值比较差异均无统计学意义(P>0.05)；NA组和GA组患者术后 24 h的舒张压最高值[(77.4±12.5) mmHg vs (85.4±13.4) mmHg]、收缩压最高值[(120.4±12.3) mmHg vs(133.5±13.4) mmHg]、心率最高值[(80.1±5.3)次/min vs (88.9±8.5)次/min]及平均动脉压最高值[(77.8±6.7) mmHg vs(86.4±10.2) mmHg]比较，NA组明显低于GA组，差异均有统计学意义(P<0.05)；NA组和GA组患者术后的第2、4及8小时的VAS评分≤3分病例数(100.0% vs 66.7%、93.3% vs 53.3%、74.7% vs 26.7%)、需应用额外镇痛药物的患者病例数(0 vs 10.7%、4.0% vs 20.0%、28.0% vs 60.0%)比较，NA组明显多于GA组，差异均有统计学意义(P<0.05)；NA组和GA组患者术后的第一次进食饮水的时间[(30.1±2.9) min vs (210.3±4.1) min]、下床活动时间[(34.8±4.8) min vs(258.9±5.4) min]、平均住院时间[(6.8±0.3) d vs (7.3±0.3) d]比较，NA组明显短于GA组，差异均有统计学意义(P<0.05)；NA组患者的不良反应的发生率为4.0%，明显低于GA组的25.3%，差异有统计学意义(P<0.05)。结论 超声引导下选择性颈神经根阻滞联合全麻对肩袖损伤肩关节镜手术患者的血流动力学更稳定，疼痛评分较低，明显优于单纯全麻，值得临床推广。
      【关键词】 超声；选择性颈神经根阻滞；全麻；肩袖损伤；肩关节镜手术；血流动力学；术后镇痛
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2020）04—0446—04

Effects of ultrasound-guided selective cervical nerve root block combined with general anesthesia onhemodynamics and postoperative analgesia in shoulder cuff injury patients undergoing arthroscopic shouldersurgery.
ZHAO Li, HUANG Hong-yan, JIN Ting. Department of Anesthesiology, Shenzhen Yantian District People'sHospital, Shenzhen 518081, Guangdong, CHINA
【Abstract】 Objective To study the effect of ultrasound-guided selective cervical nerve root block combinedwith general anesthesia on hemodynamics and postoperative analgesia in patients with rotator cuff injury undergoing ar-throscopic shoulder surgery. Methods A retrospective analysis was performed on the diagnosis, treatment, and anesthesiaof 150 patients with rotator cuff injury who underwent arthroscopic shoulder surgery in Shenzhen Yantian District People'sHospital from March 2017 to March 2019. According to the different ways of anesthesia, the patients were divided into theNA group and GA group, with 75 patients in each group. Routine general anesthesia was performed in the GA group, andultrasound-guided selective cervical nerve root block combined with general anesthesia was performed in the NA group.The postoperative hemodynamic indicators of first 24 h, the time of first eating and drinking, the time of getting out ofbed, the length of hospital stay, the pain and the occurrence of adverse reactions of the two groups were compared and ana-lyzed. Results There was no significant difference between the NA group and GA group in diastolic pressure, systolicpressure, heart rate, and mean arterial pressure (P>0.05); the highest diastolic pressure, the highest systolic pressure, andthe highest heart rate in the NA group were (77.4±12.5) mmHg, (120.4±12.3) mmHg, (80.1±5.3) times/min, respectively,which were significantly lower than corresponding (85.4±13.4) mmHg, (133.5±13.4) mmHg, (88.9±8.5) times/min in theGA group (all P<0.05). At 2 h, 4 h and 8 h after the treatment, the case ratio of VAS score≤3 (100.0% vs 66.7%, 93.3%vs 53.3%, 74.7% vs 26.7%) and the case ratio of the patients who needed additional analgesics (0 vs 10.7%, 4.0% vs 20.0%,28.0% vs 60.0%) in the NA group was significantly higher than those in the GA group (all P<0.05); the time of first eatingand drinking, the time of getting out of bed and living, and the average length of hospital stay in the NA group were (30.1±2.9) min, (34.8±4.8) min, (6.8±0.3) d, respectively, which were significantly shorter than corresponding (210.3±4.1) min,(258.9±5.4) min, (7.3±0.3) d in the GA group (all P<0.05); the incidence of adverse reactions in the NA group was 4.0%versus 25.3% in the GA group (P<0.05). Conclusion Ultrasound-guided selective cervical nerve root block combinedwith general anesthesia has more stable hemodynamics and lower pain score in shoulder arthroscopic surgery for rotatorcuff injury, which is obviously superior to ge