地佐辛联合头皮神经阻滞超前镇痛对开颅患者术后疼痛及应激影响

Effects of dezocine combined with scalp nerve block preemptive analgesia on postoperative pain and stress response in patients undergoing cerebral surgery

目的:观察地佐辛联合头皮神经阻滞超前镇痛对开颅患者术后疼痛及应激的影响。方法:选择开颅手术患者120例,随机分为2组(n=60),头皮神经阻滞组(N组),地佐辛联合头皮神经阻滞组(S组)。N组患者于麻醉诱导前15 min静脉注射生理盐水2 mL,于切皮前10 min采用0.5%罗哌卡因行眶上神经(2 mL)、耳颞神经(5 mL)、枕大神经(5 mL)、枕小神经(5 mL)神经阻滞;S组患者诱导前15 min静脉注射地佐辛10 mg,切皮前10 min采用0.5%罗哌卡因行眶上神经(2 mL)、耳颞神经(5 mL)、枕大神经(5 mL)、枕小神经(5 mL)神经阻滞,分别记录2组患者清醒拔管后即刻(T1)、1 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)及48 h(T6)视觉模拟评分(VAS)与格拉斯哥昏迷量表评分(GCS),并于T1、T5、T6时点抽取动脉血测定肾上腺素(E)、去甲肾上腺素(NE)及皮质醇(Cor)浓度。结果:S组在T3、T4、T5及T6时点VAS评分低于N组(P<0.05),S组在T1、T5及T6时点E、NE及Cor浓度均低于N组(P<0.05)。结论:地佐辛联合头皮神经阻滞超前镇痛较单一头皮神经阻滞镇痛效果更佳,能更好抑制应激反应的发生。

OBJECTIVE To investigate the effect of dezocine combined with scalp nerves block preemptive analgesia on postoperative pain and stress response in patients undergoing cerebral surgery.METHODS One hundred and twenty patients undergoing cerebral surgery were randomly divided into 2 groups（n=60 each）：scalp nerves block group（group N）,dezocine combined with scalp nerves block（group S）.Patients in group N received normal saline 2 mL intravenously 15 min before anesthesia induction and scalp nerves block with 0.5%ropivacaine 10 mins before operation,including supraorbital nerve（2 mL）,auriculotemporal nerve（5 mL）,great occipital nerve（5 mL）and lesser occipital nerve（5 mL）.Patients in group S received dezocine 10 mg intravenously 15 min before anesthesia induction and scalp nerves block with0.5%ropivacaine 10 min before operation.The VAS score and GCS score were recorded immediately（T1）,1 h（T2）,6 h（T3）,12 h（T4）,24 h（T5）and 48 h（T6）after extubation,the levels of epinephrine（E）,norepinephrine（NE）,cortisol（Cor）in plasma were recorded at T1,T5 and T6.RESULTS The VAS scores in group S were significantly lower than those in group N at T3,T4,T5 and T6.The levels of epinephrine（E）,norepinephrine（NE）,plasma cortisol（Cor）were decreased than those in group N at T1,T5 and T6.CONCLUSION Dezocine combined with scalp nerves block preemptive analgesia can provide better postoperative analgesia and alleviate stress response in patients undergoing cerebral surgery.