全麻复合颈丛阻滞在颈椎后-前路手术中应用的可行性探讨

Feasibility of general anesthesia combined with cervical plexus block on posterlor-anterior cervical vertebra surgery

目的探讨全麻复合颈丛阻滞对颈椎后-前路手术的安全性和有效性。方法选择颈椎骨折伴颈髓损伤行颈椎后-前路同期手术患者60例,美国麻醉医师协会(ASA)标准Ⅰ～Ⅲ级,年龄16～70岁,随机分为单纯全麻组(A组)和全麻复合颈丛阻滞组(B组),每组30例。A组全麻诱导插管后,术中用微泵输注异丙酚2～3 mg/kg,吸入异氟醚,并间断追加芬太尼和维库溴铵维持麻醉;B组在A组全麻的基础上待颈椎后路手术操作完成后,由颈椎前路手术开始前再行右术侧颈深、浅丛阻滞,手术切口超颈正中线者同时阻滞对侧颈浅丛。记录两组患者麻醉维持用药量及术毕自主呼吸恢复、指令反应、拔管和拔管至完全清醒所需时间。结果两组患者在手术前期颈椎后路手术全麻用药异丙酚、芬太尼、维库澳铵、异氟醚吸入量差异均无统计学意义(P均>0.05);但B组颈椎前路手术辅助颈丛阻滞镇痛,仅用异丙酚镇静,而A组亦仍需间断追加芬太尼、维库溴铵等全麻药维持。B组术后至自主呼吸恢复、指令睁眼、拔管、拔管后至完全清醒所需时间与A组比较均明显缩短(P均<0.01),且拔管后气道通气良好。结论颈椎后-前路同期手术在全麻的基础上辅助颈丛阻滞可显著减少颈椎(前路)手术后期全麻用药量,有利于患者术后早期清醒与拔管,并可提高拔管后的安全性。

Objective To observe safety and efficacy of general anesthesia combined with cervical plexus block on cervical vertebral surgery via both posterior and anterior routes simultaneously. Methods Sixty patients, 16 -70 years in age, suffered from cervical vertebral fracture with cervical spinal cord injury underwent cervical vertebral surgery via both posterior and anterior routes simultaneously, and according to the surgical grades of American surgical association （ASA）, the surgeries were Ⅰ -Ⅱ grades. The patients were randomly allocated into pure general anesthesia group （A） and general anesthesia combined with cervical plexus block group （B）, 30 cases being in each group. After intubation for general anesthesia induction, the patients in group A were maintained by continuous propofol injection （2 - 3 mg/kg） by mlcro-pump, 0. 5 %- 1.0% isoflurane inhalation and intermittent injections of fentanyl and vecuronium to maintain muscular relaxation. After completion of posterior cervical vertebral surgery based on similar general anesthesia in group A and before the beginning of the anterior route surgery, the patients in group B received deep and superficial cervical plexus block on the right side, and if the surgical incision traversed the central vertical line of the neck, the opposite nerve plexus was also blocked. The dosages of various agents for maintaining anesthesia, the duration between the completion of surgery and the recovery of spontaneous breathing, times for initial conscious reaction, extubation and from extubation to complete recovery were recorded in the two groups. Results Between the two groups, there were no significant differences in dosages of propofol, fentanyl, vecuronium and isoflurane used （all P〉0. 05） in the former part of the surgery that was before the beginning of the surgery via anterior route. But in group B, only propofol for sedation was used for the patients during the latter part of the surgery via the anterior route or while the nerve plexus was blocked; during this time in group A, the addition of fentanyl and vecuronium were still intermittently necessary to maintain the general anesthesia. The duration between the completion of surgery and the recovery of spontaneous breathing, times for initial conscious reaction such as opening the eyes following an order, extubation and from extubation to complete recovery were significantly shorter in group B than those in group A （all P〈0.01）, and the patients in group B ventilated well after extubation. Conclusion In the cervical vertebral surgery via both posterior and anterior routes simultaneously, the addition of cervical plexus block on the general anesthesia can decrease the dosages of various agents for maintaining anesthesia in the latter part of the surgery via the anterior route, thus the method is beneficial to the early recovery of consciousness, early extubation after surgery and enhances the safety after extubation.