颈动脉体瘤切除术采用颈丛阻滞复合病人自控镇痛术的临床应用  

Clinical application of cervical plexus block combined with PCA for excision of carotid aneurysm

作　　者：黄燕[1] 朱也森[1] 

机构地区：[1]上海第二医科大学附属第九人民医院麻醉科,200011

出　　处：《上海医学》2002年第8期493-495,共3页Shanghai Medical Journal

摘　　要：目的　用全身麻醉和颈丛阻滞复合静脉病人自控镇痛术 (PCA)两种方式 ,进行颈动脉体瘤切除术 ,旨在比较两种麻醉方式的优缺点 ,及后者麻醉方式的可行性。方法　收集颈动脉体瘤切除术病例 17例 ,随机分为两组 ,全麻组 8例 ,病人在全身麻醉下施行手术 ,颈总动脉阻断后 ,施行术中唤醒试验 ,确诊无偏瘫后将颈动脉体瘤切除。试验组 9例 ,用颈丛阻滞复合静脉PCA ,负荷给予小剂量的芬太尼和咪达唑仑 ,保持术中病人神志清醒 ,及时了解颈总动脉阻断后脑缺血的状况 ,并将瘤体切除。结果　两组手术的麻醉方式均达到满意的效果。结论　应用患侧颈丛阻滞复合静脉PCA给药 ,有利于术中的观察 ,可以避免较为严重的脑血管意外 ,将PCA提前在手术中应用是一种简单而实用的方法 。Objective General anesthesia or cervical plexus block combined with PCA was applied in the operations for the excision of carotid aneurysm, with the aim of comparing the advantages and disadvantages of these two methods and the clinical applicability of the latter.Methods 17 cases of carotid aneurysm were divided randomly into 2 groups. The control group consisted of 8 cases who were operated under general anesthesia. Interoperation wake-up test was performed after the blood flow of the carotid artery was blocked, with absence of hemiplegia before excision of the carotid aneurysm. The study group consisted of 9 cases which were operated by cervical plexus block combined with intravenous PCA. Minimal dosage of Fentanyl and Midazolam were administered and the patients remained awake during the operations. While monitoring the signs and symptoms of cerebral hypoxia after the blood flow of the carotid artery was blocked, the carotid aneurysm was excised. Results Satisfactory results of anesthesia were obtained in both two groups. Conclusion The application of cervical plexus block combined with PCA was advantageous to the interoperative monitoring and prevention of severe brainsroke. The use of interoperative PCA can be recognized as a simple and effective method, and feasible for wider clinical use.

关 键 词：颈动脉体瘤切除术 临床应用 颈动脉体瘤 颈丛阻滞 病人自控镇痛 PCA 

分 类 号：R614[医药卫生—麻醉学]