超声引导下右侧颈浅丛神经阻滞复合全麻在择期接受颈前路手术的颈椎病患者中的应用效果  

The Application Effect of Ultrasound-Guided Right Superficial Cervical Plexus Block Combined with General Anesthesia in Patients with Cervical Spondylosis Who Underwent Elective Anterior Cervical Surgery

作　　者：吕素平[1] LYU Suping(Department of Anesthesia and Perioperative Medicine,Henan Provincial People's Hospital,Zhengzhou Henan 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,河南郑州450003

出　　处：《临床研究》2022年第11期91-96,共6页Clinical Research

摘　　要：目的探究超声引导下右侧颈浅丛神经阻滞复合全麻在择期接受颈前路手术的颈椎病患者中的应用效果。方法选取河南省人民医院2018年8月至2020年5月择期接受颈前路手术的94例颈椎病患者,使用随机数字表法分组,各47例。对照组采用全麻,观察组采用超声引导下右侧颈浅丛神经阻滞复合全麻。对比两组麻醉诱导前(T_(1))、插管后(T_(2))、切皮时(T_(3))、拔管时(T_(4))心率(HR)、舒张压(DBP)、收缩压(SBP),术中瑞芬太尼用量、补救镇痛率;术后6 h、术后12 h、术后24 h疼痛视觉模拟评分法(VAS)评分;术前及术后1 d、术后3 d血浆皮质醇、血糖水平,术前1 d及术后1 d恢复质量(QOR-40)评分,并于术前1 d、术后1 d、术后3 d、术后7 d运用简易智力状态检查量表(MMSE)评估患者的认知功能;机体微循环[经皮氧分压(TcPO_(2))、经皮二氧化碳分压(TcPCO_(2))、血乳酸(Lac)数值]及不良反应发生率。结果T_(2)、T_(3)、T_(4)观察组HR、DBP、SBP低于对照组,差异有统计学意义(P<0.05);观察组术中瑞芬太尼用量、补救镇痛率低于对照组,差异有统计学意义(P<0.05);观察组术后6 h、术后12 h、术后24 h VAS评分低于对照组,差异有统计学意义(P<0.05);术后1 d、术后3 d两组血浆皮质醇、血糖水平高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后3 d两组血浆皮质醇、血糖水平低于术后1 d,差异有统计学意义(P<0.05);观察组术后1 d身体舒适度、心理支持、情绪状态、疼痛评分、QOR-40总分高于对照组,差异有统计学意义(P<0.05);术后第1 d、术后3 d观察组MMSE评分均较对照组高,差异有统计学意义(P<0.05),术后第7 d两组MMSE评分比较,差异无统计学意义(P>0.05);观察组吞咽困难、恶心呕吐发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导下右侧颈浅丛神经阻滞复合全麻应用于择期接受颈前路手术的颈椎病患者,维持术中Objective To explore the application effect of ultrasound-guided right superficial cervical plexus block compound general anesthesia in patients with cervical spondylosis who undergo selective anterior cervical surgery.Methods A total of 94 patients with cervical spondylosis who underwent selective anterior cervical surgery in Henan Province People's Hospital from August 2018 to May 2020 were prospectively selected as the subjects of the study.They were randomly divided into observation group and control group,with 47 cases in each group.The control group implemented general anesthesia,and the observation group implemented ultrasound-guided right superficial cervical plexus block compound general anesthesia.The heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP),remifentanil dosage,rescue analgesia rate before induction(T_(1)),after intubation(T_(2)),during peeling(T_(3)),and during extubation(T_(4)),visual analogue scale(VAS)score at 6 h,12 h and 24 h after operation,plasma cortisol and blood glucose levels before operation and 1st day and 3rd days after operation,and recovery quality score(QOR-40)1st day before operation and 1st day after operation were compared between the two groups.The cognitive function was assessed by using the simple mental status examination scale(MMSE)preoperatively at 1 d,1 d,3 d and 7 d;The microcirculation[percutaneous partial pressure of oxygen(TcPO_(2)),percutaneous partial pressure of carbon dioxide(TcPCO_(2)),blood lactic acid(Lac)]and the incidence of adverse reactions were evaluated.Results HR,DBP and SBP at T_(2),T_(3) and T_(4) in observation group were lower than those in control group,the differences were statistically significant(P<0.05);The dosage of remifentanil and rescue analgesia rate in observation group were lower than those in control group,the differences were statistically significant(P<0.05);The scores of VAS in observation group were lower than those in control group at 6 h,12 h and 24h after operation,the differences were statistically si

关 键 词：超声引导 颈浅丛神经阻滞 全麻 颈前路手术 颈椎病 

分 类 号：R653[医药卫生—外科学]