【罂粟摘要】肩关节镜对肌间沟臂丛超声图像质量的影响:一项术前与术后的比较研究
肩关节镜对肌间沟臂丛超声图像质量的影响:一项术前与术后的比较研究
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
肩关节镜手术中，液体从肩关节腔外渗并随后被吸收到邻近软组织中是一种有据可查的现象。我们旨在确定肌间沟臂丛神经超声成像的质量差异是否与实施肌间沟神经阻滞的时间有关(术前或术后)。
这项单中心、前瞻性观察研究采用了前后测量方法，比较了29名接受肩关节镜检查的患者术前和术后的肌间沟臂丛神经超声图像，其中个体患者作为自身对照。三名经过专业培训的区域阻滞麻醉医生使用李克特量表法评估了每次超声扫描的图像质量和执行神经阻滞的信心。超声扫描的图像质量与患者的年龄、性别、体重指数、手术持续时间、有无阻塞性睡眠呼吸暂停和关节镜冲洗液量的关系被作为次要结果纳入分析。
超声显像质量的总体术前平均评分高于术后评分(术前4.5 vs术后3.8；p<0.001)，麻醉医生根据超声图像执行阻滞的信心也是如此(术前4.8 vs术后4.2；p<0.001)。较大的体重指数对术前臂丛神经的可视化有负面影响(两种体重类别；p < 0.05)。与低风险组相比，中高风险组或经证实明确患有阻塞性睡眠呼吸暂停的患者的术后综合平均评分较低(3.4 vs 4.0 p< 0.05)，麻醉医生执行阻滞的信心同样较低(3.8 vs 4.4 p<0 .05)。
肩关节镜检查术后肌间沟臂丛神经的超声显像质量可能下降，我们提倡在条件允许的情况下进行术前肌间沟神经阻滞。
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.
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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