下牙槽神经阻滞复合全身麻醉在下颌骨骨折固定术中的应用

Alveolar Nerve Block Combined With General Anesthesia in Mandibular Fracture Fixation Surgery

目的探讨下牙槽神经阻滞复合全身麻醉在下颌骨骨折固定术中的应用价值。方法选择2013年1月~2015年12月52例ASAⅠ~Ⅱ级下颌骨体部单发骨折患者,随机分为2组:A组采用Akinosi-Vazirani法下牙槽神经阻滞复合全身麻醉;B组单纯采用全身麻醉。记录术前、手术开始10 min、拔除气管导管即刻和拔管后10 min平均动脉压(MAP)、心率(HR),并记录手术时间、手术结束至拔除气管导管时间(拔管时间)、阿片类镇痛药物用量、拔管后10 min的疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Ramsay镇静评分及下牙槽阻滞并发症。结果与B组相比,A组拔管时间短[(4. 0±0. 4)min vs.(8. 4±0. 4) min,t=-39. 409,P=0. 000],瑞芬太尼使用量少[中位数253. 4 (四分位数249. 2,255. 2)μg vs. 262. 7(259. 9,265. 0)μg,Z=-6. 004,P=0. 000],拔管即刻和拔管后10 min疼痛VAS评分低[(2. 0±0. 4)分vs.(2. 7±0. 4)分,t=-5. 622,P=0. 000;(2. 8±0. 5)分vs.(3. 9±0. 4)分,t=-9. 248,P=0. 000],拔管即刻和拔管后10 min Ramsay镇静评分低[(3. 0±0. 3)分vs.(3. 3±0. 2)分,t=-4. 177,P=0. 000;(1. 9±0. 3)分vs.(2. 4±0. 2)分,t=-6. 607,P=0. 000]。不同时点2组MAP和HR均有波动,但A组更平稳。结论与单纯全身麻醉相比,Akinosi-Vazirani法下牙槽神经阻滞复合全身麻醉拔管时间更短,瑞芬太尼的使用量也较少,血流动力学较稳定,术后镇痛和镇静效果好,无明显不良反应和并发症。

Objective To explore the application value of alveolar nerve block combined with general anesthesia in mandibular fracture fixation surgery. Methods Fifty-two patients with ASA grade Ⅰ-Ⅱ isolated mandibular fractures between January 2013 and December 2015 were randomly divided into 2 groups: Group A was treated with Akinosi-Vazirani alveolar nerve block combined with general anesthesia;Group B was treated with general anesthesia alone. The mean arterial pressure (MAP) and heart rate (HR) were recorded before operation, 10 minutes after operation, immediately at the time of tracheal extubation and 10 minutes after tracheal extubation. The operation time, the time from the end of operation to the tracheal extubation (extubation time), the dosage of opioid analgesics, the Visual Analogue Scale (VAS) pain score 10 minutes after extubation, the Ramsay sedation score, and complications of alveolar nerve block were also recorded. Results As compared with the Group B, the Group A had shorter extubation time [(4.0±0.4) min vs.(8.4±0.4) min, t =-39.409, P =0.000]. The use of remifentanil in the Group A was also less than that in the Group B [median, 253.4 ( P 25 : 249.2, P 75 : 255.2)μg vs. 262.7 (259.9,265.0)μg, Z =-6.004, P =0.000]. The VAS pain scores of the Group A immediately after extubation and 10 minutes after extubation were significantly lower than those of the Group B [(2.0±0.4) points vs.(2.7±0.4) points, t =-5.622, P =0.000;(2.8±0.5) points vs.(3.9±0.4) points, t =-9.248, P =0.000]. As compared with the Group B, the Ramsay sedation scores of the Group A immediately after extubation and 10 minutes after extubation were significantly lower than those of the Group B [(3.0±0.3) points vs.(3.3±0.2) points, t =-4.177, P =0.000;(1.9±0.3) points vs.(2.4±0.2) points, t =-6.607, P =0.000]. The MAP and HR of the two groups changed with time, but the changes at each time point in the Group A were more stable as compared to the Group B. Conclusion As compared with general anesthesia alone, Akinosi-Vazirani alveolar nerve block combined with general anesthesia has shorter extubation time, less remifentanil use, more stable hemodynamics, and better postoperative analgesic and sedative effects, with no obvious adverse reactions or complications.