脑电双频指数监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的应用效果OA
Application Effect of Axillary Brachial Plexus Block Combined General Anesthesia in Shoulder Arthroscopic Surgery under Bispectral Index Monitoring
目的:探究脑电双频指数(BIS)监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的应用效果.方法:选择 2020 年 1 月—2023 年 1 月在宁夏医科大学总医院、吴忠市人民医院进行肩关节镜手术的患者 86 例,应用随机数字表法将其分为对照组(采用BIS监测下锁骨上入路臂丛神经阻滞复合全身麻醉)及观察组(采用BIS监测下腋路臂丛神经阻滞复合全身麻醉),各 43 例.对比两组不同时刻[麻醉前(T0)、气管插管即刻(T1)、切皮时(T2)、拔管时(T3)]心率(HR)、平均动脉压(MAP)、BIS值;对比两组麻醉苏醒后及术后 2、12 h疼痛评分[视觉模拟评分法(VAS)]、肌力评分;对比两组术中舒芬太尼用量;对比两组不良反应发生率.结果:T0 时,两组HR、MAP比较,差异均无统计学意义(P>0.05);T1、T2、T3 时,观察组HR、MAP均低于对照组,差异均有统计学意义(P<0.05);T0、T1、T2 时,两组BIS比较,差异均无统计学意义(P>0.05);观察组T3 时BIS高于对照组,差异有统计学意义(P<0.05).观察组麻醉苏醒后及术后 6、12 h的VAS评分均低于对照组,肌力评分均高于对照组,差异均有统计学意义(P<0.05).两组不良反应发生率比较,差异无统计意义(P>0.05).结论:BIS监测下腋路臂丛神经阻滞复合全身麻醉在肩关节镜手术中的麻醉效果显著,可稳定血流动力学,患者术后疼痛程度较轻,对肌力影响较小,安全性较高.
Objective:To investigate the application effect of axillary brachial plexus block combined general anesthesia in shoulder arthroscopic surgery under bispectral index(BIS)monitoring.Method:A total of 86 patients underwent shoulder arthroscopic surgery in General Hospital of Ningxia Medical University and Wuzhong People's Hospital from January 2020 to January 2023 were selected.The patients were divided into control group(supraclavicular brachial plexus block combined general anesthesia under BIS monitoring)and observation group(axillary brachial plexus block combined general anesthesia under BIS monitoring)according to random number table method,43 cases in each group.The heart rate(HR),mean arterial pressure(MAP)and BIS values were compared between the two groups at different times[before anesthesia(T0),immediately after tracheal intubation(T1),at incision(T2),and at extubation(T3)].The pain score[visual analogue scale(VAS)]and muscle strength score were compared between the two groups at the time of anesthesia awakening and 2 and 12 h after surgery.The intraoperative dosage of Sufentanil was compared between the two groups.The incidence of adverse reactions was compared between the two groups.Result:At T0,there were no significant differences in HR and MAP between the two groups(P>0.05).At T1,T2 and T3,HR and MAP in observation group were lower than those in control group,the differences were statistically significant(P<0.05).At T0,T1 and T2,there were no significant differences in BIS value between the two groups(P>0.05).The BIS value at T3 in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).VAS scores of the observation group were lower than those of the control group and muscle strength scores of the observation group were higher than those of the control group at the time of anesthesia awakening and 6 and 12 h after surgery,the differences were statistically significant(P<0.05).The intraoperative dosage of Sufentanil in the observation group was less than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Axillary brachial plexus block combined general anesthesia under BIS monitoring has significant anesthetic effect in shoulder arthroscopic surgery,which can stabilize hemodynamics,and the postoperative pain degree of patients is less,the influence on muscle strength is less,and the safety is high.
王鹏;邹丽丽;张晓娟
宁夏医科大学总医院麻醉与围术期医学科 宁夏 银川 750004吴忠市人民医院麻醉科 宁夏 吴忠 751100
脑电双频指数监测腋路臂丛神经阻滞全身麻醉肩关节镜手术肌力评分
Bispectral index monitoringAxillary brachial plexus blockGeneral anesthesiaShoulder arthroscopic surgeryMuscle strength score
《中国医学创新》 2024 (010)
15-19 / 5
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