罗哌卡因头皮神经阻滞联合瑞芬太尼在颅骨钻孔引流术中血流动力学的影响

Effect of ropivacaine scalp nerve block combined with remifentanil on hemodynamics during cranial drilling and drainage

目的研究罗哌卡因头皮神经阻滞联合瑞芬太尼在颅骨钻孔引流手术中血流动力学的影响。方法选择2014年3月～2018年3月来我院行颅内血肿钻孔引流术患者40例作为研究对象,采用随机分组的方式分为研究组(n=20)和对照组(n=20)。其中研究组于诱导插管后视手术区域以0.4%罗哌卡因阻滞行头皮神经阻滞,对照组则不实施头皮神经阻滞。观察、记录两组患者诱导前、诱导后5min、切皮时、手术结束时平均动脉压(MAP)、心率(HR)变化;记录出现术中高血压及使用降压药物的例数。结果两组患者诱导前MAP、HR差异无统计学意义(P> 0.05);两组患者诱导后5min、切皮时、钻颅骨、手术结束时各时间点MAP显著低于诱导前(P <0.05);研究组患者诱导后5min、切皮时、钻颅骨、手术结束时各时间点MAP和HR与对照组比较,差异有统计学意义(P <0.05)。研究组术中出现高血压以及降压药物的使用率明显低于对照组,差异有统计学意义(P <0.05)。结论头皮神经阻滞可以有效地减轻手术刺激造成的血流动力学反应,减少静脉镇痛药物以及降压药物的使用,为颅骨钻孔引流术提供满意的术中、术后镇痛效果,值得推广应用。

Objective To study the effect of ropivacaine scalp nerve block combined with remifentanil on hemodynamics during cranial drilling and drainage. Methods Forty patients with intracranial hematoma after drilling and drainage in our hospital from March 2014 to March 2018 were randomly divided into study group(n=20) and control group(n=20).In the study group,0.4% ropivacaine was used for scalp nerve block in the visual surgery area after induction of intubation,while no scalp nerve block was used in the control group.The changes of before induction,5 min after induction,skin incision,mean arterial pressure(MAP)and heart rate(HR)at the time of curettage and at the end of surgery were observed and recorded.Cases of intraoperative hypertension and the use of antihypertensive drugs were recorded. Results There was no significant difference in MAP and HR between the two groups before induction(P>0.05);MAP and HR at 5 minutes after induction,skin incision,skull drilling and at the end of operation were significantly lower than those before induction(P<0.05);MAP and HR at 5 minutes after induction,skin incision,skull drilling and at the end of operation in the study group were significantly lower than those in the control group(P<0.05). The use rate of hypertension and antihypertensive drugs in the study group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05). Conclusion Scalp nerve block can effectively alleviate the hemodynamic response caused by surgical stimulation,reduce the use of intravenous analgesics and antihypertensive drugs,and provide satisfactory intraoperative and postoperative analgesic effect for skull drilling and drainage.