连续后路肌间沟臂丛神经阻滞和经静脉患者自控镇痛在肩关节镜手术患者中的应用及对预后的影响

Application of continuous posterior interscalene brachial plexus block and patient-controlled intravenous analgesia and their influences on prognosis in patients underwent arthroscopic shoulder joint surgery

摘要:

目的 探讨连续后路肌间沟臂丛神经阻滞和经静脉患者自控镇痛在肩关节镜手术中的应用效果及对预后的影响。方法 选择接受肩关节镜手术的患者128例，按随机数表法分为连续后路肌间沟臂丛神经阻滞组（N组）和经静脉患者自控镇痛组（I组），每组64例。记录术后6、12、24、48和72 h的静息和活动时疼痛视觉模拟评分（VAS）。采用ELISA法检测患者术前、术后12和24 h的外周血炎症因子和氧化应激指标水平。记录术后阿片类药物使用量、不良反应、患者满意度和肩关节功能恢复情况。结果 N组术后12、24、48和72 h静息和活动时VAS明显低于I组（P < 0.05）；N组术后12和24 h血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）和丙二醛（MDA）水平均明显低于I组（P < 0.05），两组患者SOD水平比较，差异无统计学意义（P > 0.05）。；N组术后72 h阿片类药物使用总量明显少于I组（P < 0.05）；N组满意度为95.31%，明显高于I组的79.69%（P < 0.05）。N组术后1个月美国肩肘外科协会评分（ASES）明显高于I组（P < 0.05），两组患者术后6个月ASES均明显高于术后1个月（P < 0.05）。结论 连续后路肌间沟臂丛神经阻滞应用于肩关节镜术，术后镇痛效果良好，可减轻术后炎症反应，促进患者肩关节功能恢复。

Abstract:

Objective To explore the application of continuous posterior interscalene brachial plexus block (ISBPB) and patient-controlled intravenous analgesia (PCIA) in arthroscopic shoulder joint surgery and their influences on prognosis.Methods 128 patients underwent arthroscopic shoulder joint surgery were enrolled and divided into continuous posterior ISBPB group (group N, n = 64) and PCIA group (group I, n = 64) by random number table method. The pain visual analogue scale (VAS) in resting and active status were recorded at 6, 12, 24, 48 and 72 h after surgery. The levels of peripheral blood inflammatory factors and oxidative stress indexes were detected by ELISA before and 12 h and 24 h after surgery. The postoperative usage of opioid, adverse reactions, patients satisfaction and functional exercise of shoulder joint were recorded.Results VAS scores at resting and active status at 12, 24, 48 and 72 h after surgery in group N were significantly lower than those in group I (P < 0.05). At 12 h and 24 h after surgery, levels of serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) in group N were significantly lower than those in group I (P < 0.05), but there was no significant difference in SOD level between the two groups (P > 0.05). At 72 h after surgery, total dosage of opioid in group N was significantly fewer than that in group I (P < 0.05). The patients satisfaction rate in group N was significantly higher than that in group I (95.31% vs 79.69%) (P < 0.05). 1 month after surgery, score of American Shoulder and Elbow Surgeons (ASES) in group N was significantly higher than that in group I (P < 0.05). ASES score at 6 months after surgery was significantly higher than those at 1 month after surgery in both groups (P < 0.05).Conclusion The analgesic effect of continuous posterior ISBPB is good in arthroscopic shoulder joint surgery, which can reduce postoperative inflammatory reaction and promote postoperative recovery of shoulder function.