全麻加单侧颈丛神经阻滞对颈椎前入路手术的麻醉效果观察

The Efficacy of Combination of General Anesthesia and Unilateral Cervical Plexus Nerve Block for Anterior Cervical Spine Surgery

目的观察气管插管全麻加单侧颈丛神经阻滞用于颈椎前入路手术的麻醉效果和对患者术后恢复的影响。方法选择ASAⅠ～Ⅱ级择期行颈椎前入路手术患者80例,随机分成两组,A组全麻加单侧颈丛神经阻滞组和B组单纯全麻组,每组各为40例。A组患者用0.375%的罗哌卡因10mL,行手术侧单侧颈深浅丛神经阻滞,待效果确定后再行全麻诱导。两组患者静脉麻醉诱导注射芬太尼2μg/kg、异丙酚2mg/kg、阿曲库铵0.5mg/kg,插入适宜的钢丝加强形气管导管,麻醉机行控制呼吸,监测记录麻醉前、气管插管后、切皮、分离颈椎骨膜、术毕时的心率、平均动脉压,观察两组患者的芬太尼用药量、麻醉复苏时间及术后1hVAS疼痛评分。结果两组患者手术开始切皮和分离颈椎骨膜时,A组的血压、心率明显低于B组,A组芬太尼用药量比B组少,A组麻醉复苏时间比B组缩短,术后1hVAS疼痛评分,A组平均分为4.3,B组平均分为7.2,A组患者术后疼痛比B组轻。结论全麻加单侧颈丛神经阻滞在减少术中全麻药用量、维持术中血流动力学稳定、缩短术毕麻醉复苏时间、缓解术后疼痛等方面,效果明显优于单纯全麻。

Objective To observe the effect of combination of tracheal intubation anesthesia and unilateral cervical plexus nerve block for anterior cervical spine surgery and the affection of postoperative recovery. Method 80 patients undergone anterior cervical spine surgery, ASA I ~ II, were randomly divided into two groups, each group 40 cases. Group A underwent general anesthesia plus unilateral cervical plexus nerve block and group B general anesthesia only. Group A underwent the superficial cervical plexus block of surgical side with 0.375% ropivacaine 10mL before general anesthesia induction. General anesthesia was induced with intravenous fentanyl 2~g/kg, propofol 2mg/kg and atracurium 0.5mg/kg, then the appropriate wire-strengthened endotracheal tube was inserted, breathing was controlled by anesthesia machine, HR and MAP was monitored and recorded at the time of pre-anesthesia, tracheal intubation, skin incision, separation of cervical periostenm and the end of surgery. The dosage of fentanyl, anesthesia and postoperative recovery time and VAS score at 1 hour after surgery were also recorded. Results Blood pressure and heart rates of group A was significantly lower than group B at the time of incision and separation of cervical periosteum, fentanyl used by group A was less than group B, anesthesia recovery time of group A was shorter than group B, the average VAS score at 1 hour ARer surgery of group A was 4.3 and group B were 7.2, postoperative pain of group A was less than group B. Conclusion The combination of general anesthesia and unilateral cervical plexus nerve block is significantly better than simple general anesthesia in terms of reducing the dosage of anesthetics, hemodynamic stability, the shorten of recovery time and relief of postoperative pain.