颈丛神经阻滞联合静脉全麻在乳突根治术中的应用

Application of cervical plexus block combined with intravenous general anesthesia in patients with radical mastoidectomy

目的观察颈丛神经阻滞联合静脉全麻对乳突根治术患者血流动力学及术后不良反应发生率的影响。方法将60例ASAⅠ～Ⅱ级的乳突根治术患者随机均分成两组,即颈丛神经阻滞联合静脉麻醉组(A组)和静脉麻醉组(B组)。观察切皮前,切皮即刻,切皮后1、5 min,磨电钻即刻及5 min时平均动脉压(MAP)、心率(HR)变化;观察术后VAS评分和恶心、呕吐不良反应。结果与B组比较,A组MAP、HR在切皮前1 min,切皮即刻,切皮后1、5 min和磨电钻即刻及术后24、48 h VAS评分比较差异无统计学意义(P>0.05),而A组磨电钻后5 min MAP、HR及术后1、4、12 h VAS评分比较差异有统计学意义(P<0.05)。A组术后恶心、呕吐发生率明显降低(P<0.05)。结论颈丛神经阻滞联合静脉全麻对麻醉过程中血流动力学影响小,术后不良反应发生率减少。

Objective To investigate the effect of cervical plexus block combined with intravenous general anesthesia on the variations of hemodynamics and postoperative complication incidence in patients with radical mastoidectomy. Methods Sixty ASA I - II grade patients, undergoing radical mastoidectomy were randomly devided into group A （ cervical plexus block com- bined with intravenous general anesthesia） and group B （intravenous general anesthesia）. Mean arte,3, pressure （MAP） and Heart rate（HR） were recorded before incision, and incision instantly, 1 rain, 5 rain after incision, wear electric drill instangly, 5 rain after electric drill . Visual analogue scales （VAS） scores were recorded at 1,4, 12, 24 and 48 h postoperative. Nausea and vomiting were observed postperation. Results There were no differences on MAP and HR in group A before incision, and incision instantly, 1 min, 5 rain after incision, wear electric drill instangly compare with group B. VAS scores had no significant in both groups 24 and 48 h postoperative （ P 〉 0.05）. Compare with group B, MAP and HR were increasrd significantly 5 rain after electric drill, and VAS scores were higher at 1 h, 4 h and 12 h after sugery （P 〈 0.05）. Nausea and vomiting wree de- creased significantly in group A after sugery （P 〈 0.05 ）. Conclusion Cervical plexus block combined with intravenous general anesthesia impacts little variations of hemodynamics and decreased complication incidence after sugery.