【原】【罌粟摘要】肩關(guān)節(jié)鏡對肌間溝臂叢超聲圖像質(zhì)量的影響:一項術(shù)前與術(shù)后的比較研究

罌粟花anesthGH 2021-07-24

展開全文

肩關(guān)節(jié)鏡對肌間溝臂叢超聲圖像質(zhì)量的影響:一項術(shù)前與術(shù)后的比較研究

貴州醫(yī)科大學(xué)　高鴻教授課題組

翻譯：張中偉　編輯：佟睿　審校：曹瑩

背景

肩關(guān)節(jié)鏡手術(shù)中，液體從肩關(guān)節(jié)腔外滲并隨后被吸收到鄰近軟組織中是一種有據(jù)可查的現(xiàn)象。我們旨在確定肌間溝臂叢神經(jīng)超聲成像的質(zhì)量差異是否與實施肌間溝神經(jīng)阻滯的時間有關(guān)(術(shù)前或術(shù)后)。

方法

這項單中心、前瞻性觀察研究采用了前后測量方法，比較了29名接受肩關(guān)節(jié)鏡檢查的患者術(shù)前和術(shù)后的肌間溝臂叢神經(jīng)超聲圖像，其中個體患者作為自身對照。三名經(jīng)過專業(yè)培訓(xùn)的區(qū)域阻滯麻醉醫(yī)生使用李克特量表法評估了每次超聲掃描的圖像質(zhì)量和執(zhí)行神經(jīng)阻滯的信心。超聲掃描的圖像質(zhì)量與患者的年齡、性別、體重指數(shù)、手術(shù)持續(xù)時間、有無阻塞性睡眠呼吸暫停和關(guān)節(jié)鏡沖洗液量的關(guān)系被作為次要結(jié)果納入分析。

結(jié)果

超聲顯像質(zhì)量的總體術(shù)前平均評分高于術(shù)后評分(術(shù)前4.5 vs術(shù)后3.8；p<0.001)，麻醉醫(yī)生根據(jù)超聲圖像執(zhí)行阻滯的信心也是如此(術(shù)前4.8 vs術(shù)后4.2；p<0.001)。較大的體重指數(shù)對術(shù)前臂叢神經(jīng)的可視化有負面影響(兩種體重類別；p < 0.05)。與低風險組相比，中高風險組或經(jīng)證實明確患有阻塞性睡眠呼吸暫停的患者的術(shù)后綜合平均評分較低(3.4 vs 4.0 p< 0.05)，麻醉醫(yī)生執(zhí)行阻滯的信心同樣較低(3.8 vs 4.4 p<0 .05)。

結(jié)論

肩關(guān)節(jié)鏡檢查術(shù)后肌間溝臂叢神經(jīng)的超聲顯像質(zhì)量可能下降，我們提倡在條件允許的情況下進行術(shù)前肌間溝神經(jīng)阻滯。

原始文獻來源

Jason K. Panchamia1, Ram Jagannathan, Bridget P. Pulos，et al. The effects of shoulder arthroscopy on ultrasound image quality of the interscalene brachial plexus: a pre-procedure vs post-procedure comparative study.[J]. BMC Anesthesiology (2021) 21:187:1.

英文摘要 Abstract

The effects of shoulder arthroscopy on

ultrasound image quality of the

interscalene brachial plexus: a pre-

procedure vs post-procedure comparative Study

Abstract

Background: Fluid extravasation from the shoulder compartment and subsequent absorption into adjacent soft tissue is a well-documented phenomenon in arthroscopic shoulder surgery. We aimed to determine if a qualitative difference in ultrasound imaging of the interscalene brachial plexus exists in relation to the timing of performing an interscalene nerve block (preoperative or postoperative).

Methods: This single-center, prospective observational study compared pre- and postoperative interscalene brachial plexus ultrasound images of 29 patients undergoing shoulder arthroscopy using a pretest-posttest methodology where individual patients served as their own controls. Three fellowship-trained regional anesthesiologists evaluated image quality and confidence in performing a block for each ultrasound scan using a five-point Likert scale. The association of image quality with age, gender, BMI, duration of surgery, obstructive sleep apnea, and volume of arthroscopic irrigation fluid were analyzed as secondary outcomes.

Results: Aggregate preoperative mean scores in quality of ultrasound visualization were higher than postoperative scores (preoperative 4.5 vs postoperative 3.8; p< .001), as was confidence in performing blockade based upon the imaging (preoperative 4.8 vs postoperative 4.2; p< .001). Larger BMI negatively affected visualization of the brachial plexus in the preoperative period (p < 0.05 for both weight categories). Patients with intermediate-high risk or confirmed obstructive sleep apnea had lower aggregate postoperative mean scores compared to the low-risk group for both ultrasound visualization (3.4 vs 4.0; p< .05) and confidence in block performance (3.8 vs 4.4; p< .05).

Conclusion: Due to the potential reduction of ultrasound visualization of the interscalene brachial plexus after shoulder arthroscopy, we advocate for a preoperative interscalene nerve block when feasible.

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