| 罗哌卡因用于肌间沟与臂丛上干阻滞在肩关节镜手术的临床效果对比 |
| 投稿时间：2021-05-20 修订日期：2021-08-31 点此下载全文 |
| 引用本文：周阳洋,严晓娣,张金祥,丁鹏,羊黎晔,李永华.罗哌卡因用于肌间沟与臂丛上干阻滞在肩关节镜手术的临床效果对比[J].药学实践杂志,2021,39(6):561~565 |
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| 基金项目:国家自然科学基金面上项目（81873945）；上海市“科技创新行动计划”医学创新研究专项（21Y11906400）；海军军医大学第二附属医院创新型临床研究项目（2020YLCYJ-Y18） |
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| 中文摘要:目的 探讨0.25% 罗哌卡因用于肌间沟与臂丛上干阻滞在肩关节镜手术的临床效果。方法 择期行肩关节镜下肩袖修补术的患者46例，采用随机数字法分成两组：肌间沟臂丛神经阻滞组（ISB组, n=23）和臂丛上干阻滞组（ST组, n=23）。ISB组采用一点法在C5、C6外侧注射10 ml 0.25%罗哌卡因，ST组采用环形包绕式注药方式，于臂丛上干深浅两面各注射5 ml 0.25% 罗哌卡因，共10 ml。阻滞完成后，两组采用右美托咪定镇静。对比两组患者阻滞侧膈肌麻痹（hemidiaphragmatic paresis, HDP）的程度、患侧手握力改变、术后镇痛效果以及阻滞时长。结果 阻滞后30 min，ISB组与ST组膈肌移动度下降幅度差异无统计学意义（P>0.05），阻滞后3 h，两组之间膈肌移动度下降幅度差异显著（P<0.05）；阻滞后30 min，ISB组完全HDP占8.7%，部分HDP占52.2%，ST组完全HDP为0，部分HDP占26.1%；阻滞后3 h，ISB组完全HDP为17.4%，部分HDP为65.2%，ST组完全HDP为0，部分HDP为39.1%；阻滞后30 min、3 h，ST组握力下降幅度明显低于ISB组（P<0.001）；阻滞后各时间段静息痛最高评分，ST组均优于ISB组（P<0.05）；阻滞时长方面，ISB组平均阻滞时长为（8.3±1.97）h，ST组平均阻滞时长为（10.9±1.26）h （P<0.01）。结论 10 ml 0.25%罗哌卡因臂丛上干阻滞在HDP的发生率、握力保留、术后各时间段静息痛NRS评分、阻滞时长方面均优于肌间沟臂丛阻滞。 |
| 中文关键词:臂丛上干阻滞 膈肌麻痹 肌间沟臂丛阻滞 肩关节镜 罗哌卡因 |
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| Comparison of interscalene brachial plexus block and superior trunk block with ropivacaine in shoulder arthroscopic surgery |
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| Abstract:Objective To compare the clinical effects of interscalene brachial plexus block and superior trunk block in arthroscopic shoulder surgery with 0.25% ropivacaine. Methods 46 patients undergoing shoulder arthroscopy surgery were included and randomly divided into group ISB (n=23) and group ST (n=23). Patients in group ISB received 10 ml 0.25% ropivacaine on the lateral side of C5 and C6. Patients in group ST were treated with 5 ml 0.25% ropivacaine on both sides of the superior trunk of brachial plexus. The diaphragmatic excursion, Numerical Rating Scale(NRS), duration of the block, handgrip strength were recorded at different time. Results No statistical difference was detected between the two groups in the reduction of diaphragmatic excursion within 30 min after block (P>0.05). Compared with ISB patients, ST patients had significantly less diaphragmatic excursion at 3 h after block（P<0.05). 30 minutes after block, 8.7% patients in ISB group reached complete HDP and 52.2% patients reached partial HDP. At the same time, no complete HDP and 26.1% partial HDP were detected in ST group. 3 hours after block, patients in ST group had lower complete HDP rate (0.0% vs 17.4%) and lower partial HDP rate (39.1% vs 65.2%) than patients in ISB group. At 30 minutes and 3 h after block, the reduction of grip strength in ST group was significantly lower than that in ISB group (P<0.001). ST group had lower NRS than ISB group (P<0.05). The average block time in ISB group (8.3±1.97 )h was significantly lower than that in ST group (10.9±1.26)h (P<0.01). Conclusion Superior trunk block with 10 ml 0.25% ropivacaine is superior compared to interscalene brachial plexus block in occurrence of HDP, decrease of grip strength, postoperative pain and block duration. |
| keywords:superior trunk block hemidiaphragmatic paresis interscalene brachial plexus block arthroscopic shoulder surgery ropivacaine |
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