头皮神经阻滞对颅内动脉瘤术后患者血浆皮质醇的影响  

Effect of scalp nerve block on postoperative plasma level of cortisol in patients with intracranial aneurysm

作　　者：孙志华[1] 刘大为 郭曲练[1] 贺正华[1] Zhi-hua Sun;Da-wei Liu;Qu-lian Guo;Zheng-hua He(Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2018年第26期84-87,共4页China Journal of Modern Medicine

摘　　要：目的通过术前头皮神经阻滞对颅内动脉瘤夹闭术后患者血浆皮质醇的改变,评估颅脑外科手术行头皮神经阻滞镇痛,减轻术后应激反应的效果。方法选取2016年10月-2017年5月在该院神经外科成功实施颅内动脉瘤夹闭手术的患者46例。随机分为神经阻滞组和非神经阻滞组,每组23例。神经阻滞组患者用0.5%罗派卡因分别阻滞头部两侧对称的枕大神经、枕小神经、眶上神经和耳颞神经,非神经阻滞组患者只实施全身麻醉。在快速诱导全身麻醉前,以及术后2、6、12和24 h时分别抽取外周静脉血测定血浆皮质醇水平,同期记录疼痛视觉模拟评分(VAS)和不良反应。结果神经阻滞组术后2、6和12 h的VAS评分较非神经阻滞组低(P<0.05)。两组血浆皮质醇水平术后2~24 h较快速诱导气管插管前升高(P<0.05)。与非神经阻滞组比较,神经阻滞组术后2~12 h血浆皮质醇水平降低(P<0.05)。结论 0.5%罗派卡因头皮神经阻滞是开颅术后镇痛的有效方法,可在一定程度上抑制应激反应。Objective To investigate the effect of postoperative pain on plasma cortisol and preoperative scalp nerve block on reducing postoperative stress after clipping of intracranial aneurysm.Methods Forty-six ASA I-Ⅲpatients aged 19-65 yr undergoing clipping of cerebral aneurysms were recruited and randomly divided into a preoperative scalp nerve block group(group N)and a control group(group M)with 23 in each group.The patients in the group N received scalp nerve block with 0.5%Ropivacaine after induction while those in the group M did not.The concentration of plasma cortisol was measured before induction and 2,6,12 and 24 h after surgery,and Visual Analgesia Scale(VAS)and side effects were evaluated at the same time.Results Postoperative VAS scores were significantly lower in the group N than in the group M at 2,6 and 12 h after surgery(P<0.05).The plasma level of corticosteroid was noticeably increased after surgery compared to that before general anesthesia induction intubation in both groups(P<0.05).But the plasma level of cortisol was noticeably lower in the group N than in the group M at 2-12 h after surgery(P<0.05).Conclusions Preoperative scalp nerve block with 0.5%Ropivacaine provides effective postoperative analgesia and may depress stress action after craniotomy.

关 键 词：颅内动脉瘤夹闭术 罗哌卡因 头皮神经阻滞 镇痛 血浆皮质醇 

分 类 号：R614.4[医药卫生—麻醉学]