全凭静脉麻醉复合超声引导双侧颈浅丛神经阻滞用于舌癌根治术的应用研究

Application study of total intravenous anesthesia with ultrasound-guided bilateral superficial cervical plexus block in patients undergoing radical operation for tongue cancer

目的:探讨全凭静脉麻醉复合超声引导双侧颈浅丛神经阻滞用于舌癌根治术对患者血流动力学、麻醉药物用量和苏醒质量的影响。方法:选择40例择期舌癌根治术患者,随机分为观察组(全凭静脉麻醉组)、对照组(全凭静脉复合超声引导双侧颈浅丛神经阻滞组),每组20例。分别记录两组患者麻醉诱导前(T0)、术前10 min(T1)、切皮时(T2)、手术开始1 h(T3)、手术结束(T4)、手术结束1 h(T5)6个时间点的收缩压(SBP)、舒张压(DBP)和心率(HR);记录两组患者丙泊酚和瑞芬太尼总用量、苏醒时间、术后不良反应发生率以及发生神经阻滞并发症的情况。结果:观察组T2、T4和T5时SBP水平明显低于对照组(P<0.05),观察组T2和T4时DBP和HR水平明显低于对照组(P<0.05);观察组瑞芬太尼用量显著低于对照组(P<0.05),苏醒时间明显短于对照组(P<0.05);同时观察组患者术后PONV和术后躁动发生率也明显低于对照组(P<0.05)。结论:全凭静脉麻醉复合超声引导双侧颈浅丛神经阻滞用于舌癌根治术可有效减轻患者应激反应,维持血流动力学稳定,减少术后不良反应的发生,有利于患者早期恢复。

Objective:To evaluate the effects on hemodynamics, consumption of anesthetics and wake-up quality of total intravenous anesthesia with ultrasound-guided bilateral superficial cervical plexus block in patients undergoing radical operation for tongue cancer.Methods:A total of 40 patients scheduled for radical operation for tongue cancer were enrolled in this study.Patients were assigned randomly to control group(total intravenous anesthesia, n=20)and observation group(total intravenous anesthesia with ultrasound-guided bilateral superficial cervical plexus block, n=20).Patients’ systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)before induction(T0),10 minutes before operation(T1),at skin incision(T2),1 hour after starting operation(T3),at the end of operation(T4)and at 1 hour postoperatively were recorded.Consumption of propofol and remifentanil, duration of wake-up, incidences of postoperative adverse reactions and complications of nerve blocks in both groups were also recorded.Results:Levels of SBP at T2,T4 and T5 in observation group were significantly lower than in control group(P<0.05).Levels of DBP and HR at T2 and T4 in observation group were significantly lower than in control group(P<0.05).Consumption of remifentanil in observation group was significantly lower than in control group(P<0.05),and duration of wake-up in observation group was also shorter than in control group(P<0.05).Additionally, the incidences of PONV and postoperative agitation were lower in observation group than in control group(P<0.05).Conclusion:Application of total intravenous anesthesia with ultrasound-guided bilateral superficial cervical plexus block in radical operation for tongue cancer can effectively alleviate the stress response, maintain hemodynamic stability, reduce the incidences of postoperative adverse reactions, and improve early recoveries.