全麻联合头皮神经阻滞在开颅手术中的安全性及有效性

Safety and efficacy of general anesthesia combined with scalp nerve block in craniotomy

目的分析全麻联合头皮神经阻滞在开颅手术中的安全性及有效性。方法选择2019年2月至2019年11月在我院择期行幕上占位切除术的患者42例,采用随机数字表法将其分为头皮神经阻滞组(R组)和切口浸润麻醉组(C组)。两组全麻维持均采用靶控输注丙泊酚和瑞芬太尼,R组于全麻诱导后行头皮神经阻滞,C组于切皮前行切口浸润麻醉。比较两组手术时间、麻醉时间、手术失血量、血流动力学指标、全麻药物用量、苏醒时间、疼痛评分及并发症发生情况。结果两组手术时间、麻醉时间和手术失血量无显著差异(P>0.05)。T4时,R组MAP低于C组(P<0.05);两组T0、T1、T2、T3、T5时MAP无显著差异(P>0.05)。两组不同时间点HR无显著差异(P>0.05)。两组T1、T2、T3、T4、T5时MAP、HR分别与T0时比较,差异具有统计学意义(P<0.01)。R组舒芬太尼用量少于C组(P<0.05)。R组术后2、4、6 h的VAS评分低于C组(P<0.05)。两组术后均未发生神经麻痹、恶心呕吐、谵妄、躁动、呼吸抑制、术中知晓等并发症。结论头皮神经阻滞和切口浸润麻醉均能在术中提供良好的镇痛作用,稳定患者血流动力学指标,控制术中应激反应。但头皮神经阻滞术后镇痛持续时间更长,阿片类药物应用更少。

Objective To analyze the safety and efficacy of general anesthesia combined with scalp nerve block in craniotomy.Methods A total of 42 patients who underwent selective supratentorial space occupying resection in our hospital from February 2019 to November 2019 were selected and divided into scalp nerve block group(group R)and incision infiltration anesthesia group(group C)by random number table method.Target controlled infusion of propofol and remifentanil were used to maintain general anesthesia in both groups.Scalp nerve block was performed after induction of general anesthesia in the group R,and incision infiltration anesthesia was performed before skin incision in the group C.The operation time,anesthesia time,blood loss volume,hemodynamic indexes,dosage of general anesthesia drug,recovery time,pain score and complications were compared between the two groups.Results There were no significant differences in operation time,anesthesia time and blood loss volume between the two groups(P>0.05).At T4,MAP in the group R was lower than that in the group C(P<0.05);and there were no significant differences in the MAP between the two groups at T0,T1,T2,T3 and T5(P>0.05).There were no significant difference in HR between the two groups at different time points(P>0.05).MAP and HR at T1,T2,T3,T4 and T5 in the two groups were significantly different from those at T0(P<0.01).The dosage of sufentanil in the group R was less than that in the group C(P<0.05).The VAS scores of the group R were lower than those in the group C at 2,4 and 6 h after operation(P<0.05).There were no complications such as nerve paralysis,nausea and vomiting,delirium,agitation,respiratory depression and intraoperative awareness in both groups.Conclusion Both scalp nerve block and incision infiltration anesthesia can provide good analgesic effect during operation,stabilize the hemodynamic indexes of patients,and control the stress reaction during operation.However,the duration of analgesia after scalp nerve block is longer,with less dosage of opioids.