应用头皮神经阻滞对神经外科加速康复外科患者在幕上肿瘤术中应激反应的影响  

Effect of scalp nerve block on intraoperative stress response during supratentorial tumor resection in the patients of neurosurgical accelerated rehabilitation

作　　者：屈伸[1] 马婷 陈易[1] 王建珍[1] 王志华[1] QU Shen;MA Ting;CHEN Yi;WANG Jianzhen;WANG Zhihua(Department of Anesthesiology and Perioperative Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院麻醉与围术期医学科,宁夏银川750004

出　　处：《宁夏医学杂志》2024年第10期849-852,共4页Ningxia Medical Journal

基　　金：宁夏重点研发项目(2021BEG03075,2022BEG03115)。

摘　　要：目的探讨头皮神经阻滞对神经外科加速康复手术患者围术期应激反应指标的影响。方法选取60例符合ERAS标准的择期开颅手术患者作为研究对象。将患者分为2组,1组患者接受全静脉麻醉(K组),另1组患者接受头皮神经阻滞联合全静脉麻醉(S组),每组30例。K组不进行头皮神经阻滞。S组在诱导后上头架前15 min行头皮神经阻滞。比较观察2组患者诱导前15min(T_(1))、诱导后(T_(2))、上头架(T3)、切头皮即刻(T_(4))、剪硬膜(T5)、术中(T6)、缝皮时(T_(7))、出手术室时(T_(8))各时间点的MAP、HR,以及T_(1)、T_(4)、T_(7)时皮质醇、去甲肾上腺素、β-内啡肽的水平,T_(1)、T_(4)、T_(7)、T_(8)时血糖水平。记录6 h、12 h和24 hVAS评分。结果S组T_(4)、T_(7)、T_(8)时血糖水平均低于K组(P<0.05)。2组患者T_(1)时皮质醇和去甲肾上腺素差异无统计学意义,T_(4)和T_(7)时,S组均显著低于K组(P<0.05)。S组6 h、12 h、24 h VAS评分均低于K组(P<0.05)。结论在加速康复手术方案下行开颅手术的患者进行头皮神经阻滞可以显著降低手术操作引起的应激反应,且能降低术后急性疼痛程度,提高了术后24 h恢复质量,促进患者快速康复,值得临床推广和应用。Objective To explore the effect of scalp nerve block on perioperative stress response of patients undergoing neurosurgical enhanced recovery.Methods Sixty patients who were scheduled to undergo elective craniotomy and met Enhanced recovery aftersurgery(ERAS)criteria were included.The patients were randomly divided into two groups.One group received totally intravenous anesthesia(group K).The other group received scalp nerve block combined with intravenous anesthesia(group S).The patients in group S underwent scalp nerve block 15 min before installation of the head frame after induction.MAP and HR were compared between the two groups at the following time points:15 min before induction(T_(1)),after induction(T_(2)),installing the head frame(T 3),at the moment of cutting the scalp(T_(4)),at the time of cutting the dura mater(T 5),intraoperatively(T 6),at the time of suturing the skin(T_(7)),and at the time of exiting from the operating room(T_(8)).The levels of cortisol,norepinephrine andβ-endorphin were compared between the two groups at the time points of T_(1),T_(4),and T_(7).The levels of blood glucose were compared between the two groups at the time points of T_(1),T_(4),T_(7),and T_(8).VAS6h、VAS12h and VAS24h were recorded.Results The blood glucose at T_(4),T_(7)and T_(8)in group S was lower than that in group K(P<0.05).The levels of cortisol and norepinephrine were significantly lower in group S than in group K at T_(4)and T_(7)(P<0.05).The visual analog scores were lower in group S than in group K at 6 h,12 h and 24 h(P<0.05).Conclusion The scalp nerve block can not only significantly reduce the stress reaction caused by surgical operation in patients undergoing craniotomy under ERAS protocol,but also reduce the degree of acute postoperative pain.It improves the quality of 24-hour postoperative recovery and enhanced recovery after surgery,which is worthy of clinical promotion and application.

关 键 词：快速康复外科 头皮神经阻滞 应激反应 

分 类 号：R682[医药卫生—骨科学]