颈丛神经阻滞联合全身麻醉在颈椎前路手术中的临床研究

Clinical study of cervical plexus block in combination with general anesthesia in patients undergoing anterior cervical spine surgery

目的探讨颈丛神经阻滞联合全身麻醉在颈椎前路手术中的麻醉效果。方法选择行择期颈椎前路手术的患者76例,ASA为Ⅰ～Ⅱ级,随机分为全身麻醉组(A组,n=38)和颈丛神经阻滞联合全身麻醉组(CA组,n=38)。所有患者术前均给予咪唑安定0.05mg/kg和盐酸戊乙奎醚0.02mg/kg。CA组患者在麻醉诱导前以0.5%罗哌卡因加1%利多卡因进行右侧颈深浅丛神经阻滞及左侧颈浅丛神经阻滞。两组患者给予3μg/kg芬太尼、1.5mg/kg异丙酚和0.15mg/kg维库溴铵静脉诱导,加固型螺纹气管导管经鼻行气管插管,并以芬太尼、异丙酚及维库溴铵维持麻醉。分别记录诱导前、插管前、插管后1～5min、手术切皮、分离颈椎骨膜及术毕清醒时患者无创血压、心率以及心电图ST段变化;并观察记录芬太尼用量、异丙酚用量、手术时间、麻醉苏醒时间及术后拔管时间。结果 CA组在插管后1min、手术切皮、分离骨膜及术毕清醒时,血压、心率及心电图ST段变化均明显低于A组。CA组异丙酚及芬太尼用量均低于A组,CA组麻醉苏醒时间及术后拔管时间均明显短于A组。结论颈丛神经阻滞联合全身麻醉是颈椎前路手术较为安全有效的麻醉方法。

Objective To evaluate the effects of cervical plexus block in combination with general anesthesia in patients undergoing anterior cervical spine surgery.Methods Seventy-six patients undergoing elective anterior cervical spine surgery under general anesthesia,ASA I-II,were randomly divided into two groups.Group A（n=38）underwent geneal anesthesia only and group CA（n=38）underwent cervical plexus block in combination with general anesthesia.0.05 mg/kg of midazolam and 0.02 mg/kg of penehyclidine hydrochloride were administered intravenously as premedication in all patients.Group CA additionally received right deep and superficial cervical plexus block plus left superficial cervical plexus block with 1% lidocaine and 0.5% ropivacaine before the induction of anesthesia.General anesthesia was induction with propofol 1.5 mg/kg and fentanyl 3 μg/kg.The nasotracheal intubation was performed by standard direct laryngoscopy with a flexometallic tracheal tube after intravenous administration of vecuronium bromide 0.15 mg/kg.Anesthesia was maintained with fentanyl,propofol and vecuronium bromide as needed.Invasive measured blood pressure and electrocardiogram with heart rate and automatic ST-segment analysis were recorded before induction,before tracheal intubation,every minute for five minutes after intubation,skin incision,separation of cervical periosteum and recovery from operation immediately.The dosage of propofol and fentanyl and the duration of operation,recovery and extubation were assessed.Results Blood pressure,heart rates and ST-segment change of groups CA were significantly lower than group A at the time of 1 minute after intubation,skin incision,separation of cervical periosteum and recovery from operation.The dosages of propofol and fentanyl used by group CA were less than group A.The duration of recovery and extubation of group CA were shorter than group A.Conclusion Cervical plexus block in combination with general anesthesia is a safe and effective technique for anterior cervical spine surgery.