小剂量地塞米松复合切口局部浸润麻醉对行颅骨修补术患者术后认知功能的影响  

Effect of low-dose dexamethasone combined with incision local infiltration anesthesia on postoperative cognitive function in patients undergoing cranioplasty

作　　者：童恒 庄立叶 吕玉朋 TONG Heng;ZHUANG Liye;LYU Yupeng(Department of Anesthesiology,Affiliated Li Huili Hospital,Ningbo University,Ningbo 315000,CHINA)

机构地区：[1]宁波大学附属李惠利医院麻醉科,浙江315000

出　　处：《江苏医药》2025年第2期118-121,共4页Jiangsu Medical Journal

摘　　要：目的探讨小剂量地塞米松复合切口局部浸润麻醉对行颅骨修补术患者术后认知功能的影响。方法择期行颅骨修补术患者50例随机分为A、B两组,每组25例。A组和B组术前1h分别静脉注射地塞米松0.1mg/kg(稀释至2mL)和生理盐水2mL。术中划皮前10min,两组均给予0.50%罗哌卡因20mL行切口局部浸润麻醉。比较两组围手术期麻醉时间、丙泊酚和瑞芬太尼用量;评估两组术后6、12、24和48h的VAS疼痛评分和术后补救镇痛率,评估两组术前1d和术后1、3、7和60d的简易精神状态量表(MMSE)评分,检测两组术前1d和术后1、3和7d的血清CRP水平。观察两组术后不良反应发生情况。结果两组麻醉时间、丙泊酚用量及术后恶心呕吐发生率相仿(P>0.05)。与B组比较,A组瑞芬太尼用量减少,术后12和24h的VAS疼痛评分降低,术后补救镇痛率降低,术后1、3、7d的MMSE评分升高,术后1、3d的血清CRP水平降低(P<0.05或P<0.01)。结论小剂量地塞米松复合切口局部浸润麻醉可促进行颅骨修补术患者的术后认知功能恢复,可能与减少阿片类药物使用量、延长术后镇痛效果及抑制炎症反应有关。Objective To investigate the effect of low-dose dexamethasone combined with incision local infiltration anesthesia on the postoperative cognitive function of the patients undergoing cranioplasty.Methods Fifty patients undergoing cranioplasty were randomly divided into two groups with 25 cases each.Group A and group B were intravenously injected with dexamethasone 0.1mg/kg(diluted to 2mL)and normal saline 2mL at one hour before surgery,respectively.Local infiltration anesthesia with 0.50% ropivacaine 20mL was performed at 10minutes before incision in both groups.The duration of perioperative anesthesia,the consumptions of propofol and remifentanil were compared between the two groups.The VAS pain scores at 6,12,24 and 48 hours after surgery were evaluated.The rate of postoperative remedial analgesia were compared between the two groups.The mini-mental state examination(MMSE)scores one day before surgery and on the 1^(st),3^(rd),7^(th)and 60^(th)day after surgery were evaluated.Serum CRP levels were detected one day before surgery and on the 1^(st),3^(rd)and 7^(th)day after surgery.The incidence of postoperative adverse reactions was observed.Results There were no significant differences in the duration of anesthesia,consumption of propofol and incidence of postoperative nausea and vomiting between two groups(P>0.05).Compared with group B,the consumption of remifentanil was decreased,VAS pain scores at 12 and 24 hours after surgery were decreased,rate of postoperative remedial analgesia was decreased,MMSE scores on the 1^(st),3^(rd)and 7^(th)day after surgery were increased,and serum CRP levels on the 1^(st)and 3^(rd)day after surgery were decreased in group A(P<0.05 or P<0.01).Conclusion Low-dose dexamethasone combined with incision local infiltration anesthesia can promote the recovery of the postoperative cognitive function in the patients undergoing cranioplasty,which may be related to reducing the use of opioids,prolonging postoperative analgesia and inhibiting inflammatory responses.

关 键 词：地塞米松 局部浸润麻醉 认知功能 颅骨修补术 

分 类 号：R614[医药卫生—麻醉学]