| 秦 艳,马世军,范晓英,张海鹰,张万平.后路连续肌间沟臂丛神经阻滞联合帕瑞昔布钠超前镇痛对肩关节镜手术患者的应用效果[J].,2024,(14):2737-2741 |
| 后路连续肌间沟臂丛神经阻滞联合帕瑞昔布钠超前镇痛对肩关节镜手术患者的应用效果 |
| The Application Effect of Posterior Continuous Intermuscular Groove Brachial Plexus Block Combined with Parexib Sodium for Preemptive Analgesia in Patients Undergoing Shoulder Arthroscopic Surgery |
| 投稿时间：2023-12-31 修订日期：2024-01-27 |
| DOI：10.13241/j.cnki.pmb.2024.14.026 |
| 中文关键词: 后路连续肌间沟臂丛神经阻滞 帕瑞昔布钠 超前镇痛 肩关节镜 应激反应 肩关节功能 |
| 英文关键词: Posterior continuous intermuscular groove brachial plexus block Paricoxib sodium Advanced analgesia Shoulder arthroscopy Stress response Shoulder joint function |
| 基金项目:陕西省重点研发计划项目（2022SF-517） |
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| 摘要 目的：探讨后路连续肌间沟臂丛神经阻滞联合帕瑞昔布钠超前镇痛对肩关节镜手术患者的应用效果。方法：选取2020年1月到2023年1月收治的80例肩关节镜手术患者，分为A、B、C三组，A组25例、B组25例、C组30例。A组采取常规静脉麻醉，B组采取常规静脉麻醉联合后路连续肌间沟臂丛神经阻滞组，C组患者采取后路连续肌间沟臂丛神经阻滞组联合帕瑞昔布钠超前镇痛。对比三组患者入室时（T1），手术10 min（T2），手术30 min（T3），手术结束即刻（T4）心率、血氧及血压水平变化，皮质醇（COR）、去甲肾上腺素（NE）相关应激反应指标水平变化，对比三组患者不良反应发生率，最后对所有患者进行6个月门诊复查随访，分别在术前、术后1个月、3个月、6个月采用Constant-Murley评分评价三组患者肩关节功能情况。结果：三组患者T1、T4时间三组患者心率、血氧饱和度、收缩压及舒张压对比无明显差异（P＞0.05），C组患者T2、T3时间心率、血氧饱和度、收缩压及舒张压水平明显低于A组和B组（P＜0.05），且T1到T4时间处于相对稳定状态；T1时间三组患者皮质醇（cortisol, COR）、去甲肾上腺素（norepinephrine, NE）表达水平对比无差异（P＞0.05），T2、T3时间三组患者COR、NE表达水平升高，且C组患者T2、T3、T4时间COR、NE表达水平低于A组及B组（P＜0.05）；A、B、C三组患者不良反应发生率对比无差异（P＞0.05）；三组患者术前Constant-Murley评分对比无差异，术后1个月、3个月、6个月三组患者Constant-Murley评分均升高，且C组高于A组和B组（P＜0.05）。结论：针对肩关节镜手术患者术中采取后路连续肌间沟臂丛神经阻滞组联合帕瑞昔布钠超前镇痛，可稳定患者术中血氧饱和度、心率及血压水平，降低患者术中应激反应，且安全性较高，同时还可进一步辅助患者改善远期肩关节功能。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the application effect of posterior continuous intermuscular groove brachial plexus block combined with parecoxib sodium preemptive analgesia on patients undergoing shoulder arthroscopic surgery. Methods: 80 patients who underwent shoulder arthroscopic surgery from January 2020 to January 2023 were selected. They were randomly divided into three groups: A, B, and C, with 25 cases in Group A, 25 cases in Group B, and 30 cases in Group C. Group A received routine intravenous anesthesia, Group B received routine intravenous anesthesia combined with posterior continuous intermuscular sulcus brachial plexus block group, and Group C received posterior continuous intermuscular sulcus brachial plexus block combined with parecoxib sodium for preemptive analgesia. Compare the changes in heart rate, blood oxygen, and blood pressure levels, as well as changes in stress response indicators related to cortisol (COR) and norepinephrine (NE), among the three groups of patients at entry (T1), 10 minutes of surgery (T2), 30 minutes of surgery (T3), and immediately after surgery (T4). Compare the incidence of adverse reactions among the three groups of patients. Finally, conduct a 6-month outpatient follow-up for all patients, at preoperative and postoperative 1 month and 3 months, respectively The Constant Murley score was used to evaluate the shoulder joint function of three groups of patients at 6 months. Results: There was no difference in heart rate, blood oxygen saturation, systolic and diastolic blood pressure among the three groups of patients at T1 and T4 time (P>0.05). The heart rate, blood oxygen saturation, systolic and diastolic blood pressure levels of Group C were lower than those of Group A and Group B at T2 and T3 time (P<0.05), and the T1 to T4 time was relatively stable; There was no difference in the expression levels of COR and NE among the three groups of patients at T1 time(P>0.05), while the expression levels of COR and NE were increased in the three groups at T2 and T3 time. Moreover, the expression levels of COR and NE in Group C were lower than those in Group A and Group B at T2, T3, and T4 time(P<0.05); There was no difference in the incidence of adverse reactions among patients in groups A, B and C (P>0.05); There was no difference in the preoperative Constant Murley scores among the three groups of patients. After 1 month, 3 months, and 6 months of surgery, the Constant Murley scores of the three groups of patients all increased, and Group C was significantly higher than Group A and Group B(P<0.05). Conclusion: For patients undergoing shoulder arthroscopic surgery, the combination of posterior continuous intermuscular groove brachial plexus block group and Parexib sodium for preemptive analgesia can stabilize intraoperative blood oxygen saturation, heart rate, and blood pressure levels, reduce intraoperative stress response, and have high safety. At the same time, it can further assist patients in improving long-term shoulder joint function. |
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