烟雾病患者血运重建术麻醉的优化策略:头皮神经阻滞联合全麻  

Optimization strategy for anesthesia in patients with moyamoya disease undergoing revascularization:scalp nerve block combined with general anesthesia

作　　者：李帼双 贾佳[1] 张贝贝[1] 赵黎明[1] 孙铭阳[1] 张维佳 杜思哲 栗超跃[2] 张加强[1] Li Guoshuang;Jia Jia;Zhang Beibei;Zhao Liming;Sun Mingyang;Zhang Weijia;Du Sizhe;Li Chaoyue;Zhang Jiaqiang(Department of Anesthesiology and Peripoerative Medicine,Henan Province People′s Hospital,Zhengzhou 450003,China;Department of Neurosurgery,Henan Province People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450003 [2]河南省人民医院神经外科,郑州450003

出　　处：《中华麻醉学杂志》2022年第11期1289-1292,共4页Chinese Journal of Anesthesiology

基　　金：河南省科技攻关项目(212102310686)。

摘　　要：目的:评价头皮神经阻滞联合全麻对烟雾病患者血运重建术麻醉的优化效果。方法:选择择期烟雾病血运重建术患者154例,年龄18~64岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=77):头皮神经阻滞联合全麻组(GN组)和全身麻醉组(G组)。麻醉诱导:静脉注射咪达唑仑0.05 mg/kg、舒芬太尼0.5~1.0μg/kg、罗库溴铵0.6 mg/kg和依托咪酯0.2~0.3 mg/kg。麻醉诱导气管插管后,GN组以0.5%罗哌卡因行术侧头皮神经阻滞(眶上神经阻滞、滑车上神经阻滞各2 ml,耳颞神经阻滞、枕大神经阻滞、枕小神经阻滞各3 ml),G组局部注射等容量生理盐水。吸入七氟烷,静脉泵注瑞芬太尼0.05~0.10μg·kg^(-1)·min^(-1)和顺式阿曲库铵0.1 mg·kg^(-1)·h^(-1)维持麻醉。记录术中瑞芬太尼用量、术后补救镇痛情况、恶心呕吐发生情况、术后住院时间、早期神经系统并发症发生情况。于术前、出院时和术后6个月行改良Rankin量表评分。结果:与G组比较,GN组术中瑞芬太尼用量和术后补救镇痛率降低(P<0.05),术后恶心呕吐发生率、神经系统并发症发生率、术后住院时间和各时点改良Rankin量表评分差异无统计学意义(P>0.05)。结论:头皮神经阻滞联合全麻用于烟雾病患者血运重建术可提高围术期镇痛效果,有助于实现低阿片类药物麻醉模式。Objective To evaluate the efficacy of scalp nerve block combined with general anesthesia in optimizing anesthesia in the patients with moyamoya disease undergoing revascularization.Methods A total of 154 patients with moyamoya disease,aged 18-64 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,undergoing elective revascularization,were divided into 2 groups(n=77 each)using a random nunber table method:scalp nerve block combined with general anesthesia group(GN group)and general anaesthesia group(G group).Anesthesia was induced with intravenous midazolam 0.05 mg/kg,sufentanil 0.5^(-1).0μg/kg,rocuronium 0.6 mg/kg and etomidate 0.2-0.3 mg/kg.After the patients were tracheally intubated after anesthesia induction,ipsilateral scalp nerve block(2 ml for supraorbital nerve block,2 ml for supratrochlear nerve block;3 ml for auriculotemporal nerve block,3 ml for greater occipital nerve block,3 ml for less occipital nerve block)was performed with 0.5%ropivacaine in GN group.The equal volume of normal saline was locally injected in G group.Anesthesia was maintained by inhalation of sevoflurane and intravenous infusion of remifentanil 0.05-0.10μg·kg^(-1)·min^(-1)and cisatracurium 0.1 mg·kg^(-1)·h^(-1).The consumption of intraoperative remifentanil,requirement for postoperative rescue analgesia,nausea and vomiting,length of postoperative hospital stay,and early neurological complications were recorded.The modified Rankin Scale scores were evaluated before operation,at discharge and at 6 months after operation.Results Compared with G group,the consumption of intraoperative remifentanil and requirement for postoperative rescue analgesia were significantly decreased(P<0.05),and no significant change was found in the incidence of postoperative nausea and vomiting,incidence of neurological complications,length of postoperative hospital stay,and modified Rankin Scale scores at each time point in GN group(P>0.05).Conclusions Scalp nerve block combined with general anesthesia can increase the p

关 键 词：脑底异常血管网病 头皮 神经阻滞 麻醉 全身 

分 类 号：R614.2[医药卫生—麻醉学]