神经阻滞联合靶控输注技术在开颅手术麻醉中的应用  

The clinical application of scalp nerve block combined with target-controlled infusion in neurosurgical anesthesia

作　　者：孔富姣[1] 谢咏秋[1] 唐晓婷[1] 刘帆 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008 [2]湖南中医药研究院附属医院麻醉科

出　　处：《中国医师杂志》2014年第12期1617-1620,共4页Journal of Chinese Physician

摘　　要：目的 探讨神经阻滞复合靶控输注技术在神经外科麻醉应用的有效性和安全性.方法 40例因额颞顶部占位拟行病灶切除术患者按随机数字表法分为罗哌卡因神经阻滞组（R组）和对照组（C组）,每组20例.R组于诱导前以0.5％罗哌卡因阻滞耳颞神经、眶上神经和枕大神经、枕小神经行,C组不进行神经阻滞.常规麻醉诱导行气管插管后用丙泊酚和瑞芬太尼靶控输注维持麻醉.记录不同时间点的心率、平均动脉压、脑电双频指数,以及丙泊酚与瑞芬太尼使用总量、拔管时间,术后2、6、24、48 h疼痛视觉模拟评分（VAS）,术后麻醉并发症.结果 两组患者术中血流动力学均稳定,R组瑞芬太尼使用总量少于C组（t =11.10,P＜0.01）,但两组拔管时间、丙泊酚使用总量及术后并发症发生率比较差异均无统计学意义（P＞0.05）.两组术后2h和6 h VAS评分比较差异均有统计学意义（t=5.02,4.60,p＜0.01）.结论 神经阻滞复合靶控输注技术可减少颅脑手术中瑞芬太尼用量,术后镇痛效果良好.Objective To investigate the clinical application of scalp nerve block combined with target-controlled infusion in neurosurgical anesthesia.Methods 40 adult patients undergoing frontotemporal craniotomies were randomly divided into the ropivacaine scalp nerve block group （group R） and control group （group C）.The patients in group R received scalp nerve block with 0.5％ ropivacaine before induction while those in group C didnt.We used propofol and remifentanil in target-controlled infusion and atracurium in constant infusion to maintain anesthesia.The heart rate（HR）,mean arterial pressure （MAP）,bispectral index （BIS） of different time,usage of propofol and remifentanil,extubation time,visual analogue scale,and complication were recorded.Results Both groups had stable hemodynamics.The usage of remifentanil in group R was less than that of group C （t =11.10,P ＜ 0.01）.The difference of extubation time,usage of propofol,and incidence of complications were not statistically significant （P ＞ 0.05）.The difference of visual analog scale （VAS） （2 hour and 6 hour after operation） was statistically significant （t =5.02,4.60,P ＜0.O1）.Conclusions Scalp nerve block combined with target-controlled infusion is simple with less usage of remifentanil and better analgesic effect.

关 键 词：神经传导阻滞 神经外科手术 二异丙酚/投药和剂量 芬太尼/投药和剂量 麻醉 静脉/方法 输注泵 酰胺类/投药和剂量 

分 类 号：R614[医药卫生—麻醉学]