头部神经阻滞对术中全麻用药量、血流动力学和术后疼痛的影响  

Effect of scalp nerve block on the consumption of anesthetics, intraoperative hemodynamics and postoperative pain undergoing craniotomy

作　　者：王立新[1] 王保国[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京市100050

出　　处：《中国康复理论与实践》2005年第12期1023-1025,共3页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨头部神经阻滞对颅脑手术中异氟醚呼出浓度、血流动力学变化和手术后疼痛的影响。方法60例行额颞部颅脑手术患者随机分为生理盐水对照组(A组)、克泽普(复方长效利多卡因)组(B组)和罗哌卡因组(C组);麻醉诱导后进行眶上、耳颞、枕大、枕小神经阻滞,吸入异氟醚维持麻醉,控制血压在基础平均动脉压(MAP)的-20%^+10%之间。当持续出现MAP>基础值的10%,升高异氟醚浓度但不超过2倍最小肺泡气浓度,必要时静注0.5mg佩尔地平;当HR>100次/min时,静注艾司洛尔50mg。术后采用患者自控镇痛(PCA),记录术中不同时间点的血流动力学、呼气末异氟醚浓度;记录术后2h、第1天和第2天疼痛视觉模拟评分(VAS)。结果在切皮、分离骨膜、钻孔、锯骨、缝皮下、缝皮时间点,A组的异氟醚呼气末浓度高于B组和C组;在切皮即刻、切皮后、分离骨膜时,A和B组的心率和MAP增加,C组增加不明显;术后2h B组的VAS评分低于A组(P<0.05)。结论在额颞部颅脑手术中,头部神经阻滞联合全麻可以降低异氟醚浓度,减小血流动力学的变化,减轻手术后疼痛。Objective To determine the effectiveness of scalp nerve block for attenuating intraoperative hemodynamic stress, decreasing anesthetics and postoperative pain in neurosurgical patients. Methods 60 adult patients undergoing frontotemporal craniotomies were randomly divided into three groups to receive scalp nerve block with normal saline as control in group A, 0.8% lidocaine combined with 0.13% menthol in group B, and 1% ropivacaine in group C after intubation. Anesthesia was maintained with isoflurane. Mean arterial pressure （MAP） was controlled within -20%-＋10% of the baseline with isoflurane （maximum limitation of isoflurane was 2 times of minimal alveolar air concentration） and intravenous nicardipine （0.5 mg bolus iv）. Heart rate was controlled below 100 bpm with esmolol （50 mg bolus iv）. Patient controlled analgesia （PCA） with tramadol was used for the postoperative analgesia. MAP, heart rate （HR） and end tidal isoflurane concentration were monitored during craniotomy. Visual analogous score （VAS） was observed after craniotomy. Results The concentrations of end-tidal isoflurane in group A were significantly higher than that in group B and group C. MAP and HR in group A increased significantly than baseline values during operation, especially in skin incision, opening bone,while MAP and HR in group C did not increased significantly than baseline. VAS within 2 h postoperative in group B was significantly lower than that in group A （ P〈0.05）. Conclusion The scalp nerve block can effectively decrease intraoperative isoflurane concentration, attenuate hemodynamic responses and reduce postoperative pain.

关 键 词：外周神经阻滞 区域阻滞 开颅手术 

分 类 号：R614.4[医药卫生—麻醉学]