右美托咪定神经周围注射和静脉注射在超声引导下头皮神经阻滞中的应用比较

Comparison of Dexmedetomidine Peri-nerve Injection and Intravenous Injection in Ultrasoundguided Scalp Nerve Block

目的:比较右美托咪定神经周围注射和静脉注射在超声引导下头皮神经阻滞中的应用效果。方法:选取本院麻醉科2020年3月-2021年3月的90例开颅手术患者。根据右美托咪定不同给药方式将患者分为A组和B组,各45例。A组予以右美托咪定神经周围注射,B组予以右美托咪定静脉注射,两组均行超声引导下头皮神经阻滞联合全麻。比较两组血流动力学指标(动脉压、心率)、术后疼痛程度(VAS评分)、应激反应指标(FC、E、NE)、炎症因子水平(IL-6、TNF-α)以及不良反应发生情况。结果:B组插管后、切皮时、锯颅骨时、术毕时的动脉压、心率均优于A组,差异均有统计学意义(P<0.05)。术后2、6、12、24、48 h,B组的VAS评分均低于A组,差异均有统计学意义(P<0.05)。术后,B组的FC、E、NE水平均低于A组,差异均有统计学意义(P<0.05)。术后,B组的IL-6、TNF-α水平均低于A组,差异均有统计学意义(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在超声引导下头皮神经阻滞中,右美托咪定神经周围注射的应用效果优于静脉注射,可稳定患者术中的血流动力学指标,且能减轻术后疼痛、应激反应与炎症反应,且不增加不良反应发生率,有效性与安全性均较高,值得推行。

Objective:To compare the effects of Dexmedetomidine peri-nerve injection and intravenous injection in ultrasound-guided scalp nerve block.Method:A total of 90 patients underwent craniotomy in the department of anesthesiology of our hospital from March 2020 to March 2021 were selected.According to different administration methods of Dexmedetomidine,the patients were divided into group A and group B,45 cases in each group.Dexmedetomidine peri-nerve injection was given to group A,and intravenous injection of Dexmedetomidine was given to group B.Both groups received ultrasound-guided scalp nerve block combined with general anesthesia.Hemodynamic indexes(arterial pressure,heart rate),postoperative pain(VAS score),stress response indexes(FC,E,NE),inflammatory factors(IL-6,TNF-α)and the incidence of adverse reactions were compared between the two groups.Result:The arterial pressure and heart rate of group B were better than those of group A after intubation,skin cutting,skull sawing and finish operation,the differences were statistically significant(P<0.05).VAS score of group B were lower than group A at 2,6,12,24 and 48 h after operation,the differences were statistically significant(P<0.05).After operation,the levels of FC,E and NE in group B were lower than those in group A,the differences were statistically significant(P<0.05).After operation,the levels of IL-6 and TNF-αin group B were lower than those in group A,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:In the ultrasound-guided scalp nerve block,the application effect of Dexmedetomidine peri-nerve injection is better than intravenous injection.It can stabilize the intraoperative hemodynamic indexes of patients,reduce postoperative pain,stress response and inflammatory response,and does not increase the incidence of adverse reactions.It has high efficacy and safety,and is worthy of implementation.