超声引导头部神经阻滞联合监护麻醉在老年患者慢性硬膜下血肿钻孔引流术中的应用效果  

Application effect of ultrasound-guided head nerve block combined with monitored anesthesia care in chronic subdural hematoma drilling and drainage in elderly patients

作　　者：黄海燕 谢国强 高鹏 HUANG Haiyan;XIE Guoqiang;GAO Peng(Anesthesiology Department,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China;Neurosurgery Department,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China)

机构地区：[1]陕西省核工业二一五医院麻醉科,陕西咸阳712000 [2]陕西省核工业二一五医院神经外科,陕西咸阳712000

出　　处：《临床医学研究与实践》2023年第19期104-107,共4页Clinical Research and Practice

摘　　要：目的探讨超声引导头部神经阻滞联合监护麻醉(MAC)在老年患者慢性硬膜下血肿钻孔引流术中的应用效果。方法将陕西省核工业二一五医院65例老年慢性硬膜下血肿钻孔引流术患者按照麻醉方式不同分为观察组和对照组。观察组排除2例,最终纳入30例,对照组排除4例,最终纳入29例。观察组实施超声引导头部神经阻滞联合MAC,对照组未给予任何静脉麻醉药,仅手术侧切口局部麻醉。比较两组的麻醉效果。结果手术开始10、20、30 min,观察组的心率(HR)、平均动脉压(MAP)低于术前,对照组的HR、MAP高于术前(P<0.05);手术开始10、20、30 min,观察组的HR、MAP低于对照组(P<0.05)。观察组患者及外科医生的镇静镇痛满意度评分均显著高于对照组(P<0.05)。观察组的体动发生率及术毕2 h视觉模拟评分法(VAS)评分低于对照组(P<0.05);两组的呼吸抑制、呼吸道梗阻发生率无显著差异(P>0.05)。结论超声引导头部神经阻滞联合MAC对血流动力学影响小,且镇痛镇静效果确切,有利于老年慢性硬膜下血肿钻孔引流术期间的安全和舒适化医疗需求。Objective To explore the application effect of ultrasound-guided head nerve block combined with monitored anesthesia care(MAC)in chronic subdural hematoma drilling and drainage in elderly patients.Methods Sixty-five elderly patients with chronic subdural hematoma drilling and drainage in No.215 Hospital of Shaanxi Nuclear Industry were divided into observation group and control group according to different anesthesia methods.In the observation group,2 cases were excluded and 30 cases were finally included.In the control group,4 cases were excluded and 29 cases were finally included.The observation group was treated with ultrasound-guided head nerve block combined with MAC,the control group was not given any intravenous anesthetic,and only local anesthesia was performed on the surgical side incision.The anesthesia effects of the two groups were compared.Results At the beginning of surgery for 10,20,and 30 min,the heart rate(HR)and mean arterial pressure(MAP)of the observation group were lower than those before surgery,while the HR and MAP of the control group were higher than those before surgery(P<0.05);at the beginning of surgery for 10,20,and 30 min,the HR and MAP of the observation group were lower than those of the control group(P<0.05).The sedation and analgesia satisfaction scores of patients and surgeons in the observation group were significantly higher than those in the control group(P<0.05).The incidence of body movement and Visual Analogue Scale(VAS)score at 2 h after surgery in the observation group were lower than those in the control group(P<0.05);there was no significant difference in the incidence of respiratory depression and airway obstruction between the two groups(P>0.05).Conclusion Ultrasound-guided head nerve block combined with MAC has little effect on hemodynamics,and the analgesic and sedative effects are accurate,which is conducive to the safe and comfortable medical needs during the drilling and drainage of chronic subdural hematoma in the elderly.

关 键 词：慢性硬膜下血肿 超声引导头部神经阻滞 监护麻醉 钻孔引流术 

分 类 号：R651.1[医药卫生—外科学]