B超引导下头皮神经阻滞对颅内动脉瘤夹闭术患者术中血流动力学的影响  

Effects of B-Ultrasound-Guided Scalp Nerve Block on Intraoperative Hemodynamics in Patients Undergoing Intracranial Aneurysm Clipping

作　　者：高毅[1] 张保朝[1] 温昌明[1] 司小萌 孙丽[1] 孙军[1] 张萌[1] 李刚[1] 宋晓飞 王海洋[1] 钱国武[1] GAO Y;ZHANG Bao-chao;WEN Chang-ming;SI Xiao-meng;SUN Li;SUN Jun;ZHANG Meng;LI Gang;SONG Xiao-fei;WANG Hai-yang;QIAN Guo-wu(Nanyang Central Hospital Affiliated to Zhengzhou University,Nanyang 437000,China)

机构地区：[1]郑州大学附属南阳市中心医院,南阳437000

出　　处：《中国合理用药探索》2022年第2期57-63,共7页Chinese Journal of Rational Drug Use

基　　金：河南省重点研发与推广专项计划项目(192102310349);南阳市科技攻关计划项目(KJGG2018082)。

摘　　要：目的:探讨B超引导下头皮神经阻滞对颅内动脉瘤夹闭术患者术中血流动力学的影响。方法:选择本院2015年3月~2019年11月行颅内动脉瘤夹闭术的76例患者作为研究对象,按照随机数字表法分为观察组与对照组,每组38例。对照组与观察组均接受全身麻醉并且麻醉诱导与麻醉维持方案一致,观察组则在常规全身麻醉的基础上接受头皮神经阻滞。收集患者入院时的一般临床资料及各时间点的平均动脉压(MAP)和心率(HR),并抽取两组患者T_(0)~T_(4)各时间点的动脉血,测定血糖、皮质醇的含量;比较两组患者术中麻醉药物的用量,以及不良反应的发生情况。结果:与对照组相比,观察组患者术中瑞芬太尼用量减少(P<0.05);与T_(0)相比,两组患者在T_(1)~T_(4)时间点MAP与HR均降低(P<0.05),但观察组患者波动幅度小于对照组(P<0.05);与T_(0)相比,两组患者在T_(1)~T_(4)时间点血糖与皮质醇水平均增加(P<0.05);观察组患者在T_(1)~T_(4)时间点血糖与皮质醇水平均优于对照组(P<0.05);与对照组相比,观察组患者需补救镇痛以及恶心呕吐发生率均降低,镇痛持续时间增加(P<0.05)。结论:对颅内动脉瘤夹闭术患者实施B超引导下头皮神经阻滞,不仅能够有效地维持术中血流动力学的稳定,还能减少术中的应激反应,减少术后并发症,增加术后镇痛时间,值得临床推广应用。Objective:To investigate the effects of scalp nerve block guided by B ultrasound on intraoperative hemodynamics in patients with intracranial aneurysm clipping.Methods:A total of 76 patients with intracranial aneurysm clipping in our Hospital from March 2015 to November 2019 were selected as the research subjects.According to the method of random number table,the subjects were randomly divided into the observation group and the control group,with 38 patients in each group.Both the control group and the observation group received general anesthesia and the induction and maintenance of anesthesia were consistent,while the observation group received scalp nerve block in addition to conventional general anesthesia.General clinical data at admission and mean arterial pressure(MAP)and heart rate(HR)at each time point were collected,and arterial blood at each time point from T_(0)to T_(4)of patients in both groups were extracted to measure the content of blood glucose and cortisol.The amount of anesthetic drugs and the occurrence of adverse reactions were compared between the two groups.Results:Compared with control group,the amount of remifentanil in observation group was reduced(P<0.05);compared with T_(0),MAP and HR were decreased in both groups at time points T_(1)to T_(4)(P<0.05),but the fluctuation range of observation group was smaller than that of control group(P<0.05).Compared with T0,blood glucose and cortisol levels in two groups were increased from T_(1)to T_(4)(P<0.05);blood glucose and cortisol levels in observation group was better then control group from T_(1)to T_(4)(P<0.05).Compared with the control group,the incidence of remedial analgesia and nausea and vomiting in the observation group were decreased,and the duration of analgesia was increased(P<0.05).Conclusion:The application of B-ultrason-guided scalp nerve block in patients with intracranial aneurysm clipture can not only effectively maintain the stability of intraoperative hemodynamics,but also reduce intraoperative stress response,reduce posto

关 键 词：头皮神经阻滞 颅内动脉瘤夹闭术 血流动力学 应激反应 术后并发症 

分 类 号：R651[医药卫生—外科学]