超声引导与体表定位头皮神经阻滞用于术中唤醒开颅手术的效果比较  

Efficacy of ultrasound-guided versus body surface localization on scalp nerve block in awake craniotomy:report of 82 cases

作　　者：万孟宁 陈玉培[2] 邓友良 田泽丹[2] 景胜 陈远航 WAN Mengning;CHEN Yupei;DENG Youliang;TIAN Zedan;JING Sheng;CHEN Yuanhang(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Anesthesiology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing,400010;Department of Anesthesiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016 [2]重庆医科大学附属第二医院麻醉科,重庆400010 [3]陆军军医大学(第三军医大学)第二附属医院麻醉科,重庆400037

出　　处：《陆军军医大学学报》2023年第6期547-553,共7页Journal of Army Medical University

基　　金：国家自然科学基金面上项目(81172122)。

摘　　要：目的对比术中唤醒开颅手术(awake craniotomy,AC)中应用超声引导下头皮神经阻滞(ultrasound-guided scalp nerve block,US-guided SNB)与体表定位头皮神经阻滞(scalp nerve block,SNB)的效果差异。方法采用回顾性队列研究,分析2016年1月至2022年1月就诊于重庆医科大学附属第一医院及陆军军医大学第二附属医院神经外科的82例脑功能区病变患者的病历资料。其中接受US-guided SNB的纳入观察组(n=39),患者年龄(50.51±16.49)岁,男19例,体质指数(22.10±3.66)kg/m^(2)。接受体表定位SNB的纳入对照组(n=43),患者年龄(48.02±16.44)岁,男24例,体质指数(22.98±3.55)kg/m^(2)。比较两组患者的一般资料、手术相关指标及术后并发症情况。记录入室时(T0)、切皮完成时(T1)、唤醒时(T2)、唤醒后10 min(T3)、唤醒后20 min(T4)的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)。结果观察组的术中唤醒时间(6.53±1.84)min、唤醒期体动次数(4.92±2.61)次/h、盐酸尼卡地平(0.97±0.27)mg、瑞芬太尼(1.08±0.35)mg、盐酸右美拖咪定(1.30±0.33)mg以及枸橼酸舒芬太尼(22.42±2.63)ug的用量显著低于对照组,差异均有统计学意义(均P<0.05)。两组的HR在T1-T4均呈逐渐上升趋势,其中对照组HR上升更明显,组间比较差异有统计学意义(F=35.978,P<0.001)。观察组MAP在T1-T2逐渐上升,在T3-T4呈下降趋势,对照组T1-T3呈上升趋势,T4期有所回降,且明显高于观察组,组间比较差异有统计学意义(F=43.286,P<0.001)。结论US-guided SNB技术具有提升AC手术唤醒期手术质量、减少术中全身麻醉药用量、稳定血流动力学的作用。ObjectiveTo compare the efficacy of ultrasound-guided scalp nerve block(US-guided SNB)with that of body surface localization SNB in awake craniotomy(AC).MethodsA retrospective cohort study was conducted to analyze the medical records of 82 patients with brain lesions who were treated in the Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University and the Second Affiliated Hospital of Army Medical University from January 2016 to January 2022.The patients receiving US-guided SNB were included in the observation group(n=39,19 males,averagely aged 50.51±16.49 years,body mass index of 22.10±3.66 kg/m^(2)),and those receiving body surface localization SNB were enrolled in the control group(n=43,24 males,averagely aged 48.02±16.44 years,body mass index of 22.98±3.55 kg/m^(2)).The general information,operation-related indicators,and postoperative complications were compared between the 2 groups.Mean arterial pressure(MAP)and heart rate(HR)were recorded and analyzed at the time of admission(T0),skin incision(T1),awakening(T2),and 10 min(T3)and 20 min(T4)after awakening.ResultsIn the observation group,the intraoperative wake-up time(6.53±1.84 min),number of body movements during the awake period(4.92±2.61 times/h),as well as dosages of nicardipine hydrochloride(0.97±0.27 mg),remifentanil(1.08±0.35 mg),dexmedetomidine hydrochloride(1.30±0.33 mg),and sufentanil citrate(22.42±2.63 ug)were significantly lower than those in the control group,with statistical significances(all P<0.05).The HR of both groups showed a gradual upward trend at T1~T4,and the increase in the control group was much obvious with significance(F=35.978,P<0.001).The MAP of the observation group was elevated at T1~T2 and then declined at T3~T4,while the MAP in the control group was increased during T1~T3 and decreased at T4,greatly higher than that in the observation group(F=43.286,P<0.001).ConclusionUS-guided SNB technique can improve the quality of AC surgery during awake period,reduce the intraoperative dose of ge

关 键 词：超声引导 头皮神经阻滞 唤醒开颅手术 脑功能区病变 

分 类 号：R181.32[医药卫生—流行病学] R614.4[医药卫生—公共卫生与预防医学] R651.11