超声引导下颈浅丛神经阻滞联合全身麻醉在颈动脉内膜剥脱术中的应用效果

Application effect of ultrasound-guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy

目的探析在颈动脉内膜剥脱术(CEA)中应用超声引导下颈浅丛神经阻滞联合全身麻醉的效果以及对术后简易精神状态检查量表(MMSE)评分、不良反应发生率的影响。方法回顾性分析选取2020年4月至2022年4月在郑州大学附属郑州中心医院接受CEA治疗的109例患者,男女比66/43,年龄(61.41±6.24)岁。根据麻醉方案的不同将其分为对照组(54例)与观察组(55例)。对照组术前接受全身麻醉,在此基础上观察组加用超声引导下颈浅从神经阻滞。比较两组恢复情况[15项恢复质量评分量表(QoR-15)]、生命体征[心率(HR)、收缩压(SBP)、舒张压(DBP)]、认知功能(MMSE评分)及不良反应发生率。所有结果数据均导入SPSS 21.0软件进行处理,采用t检验、χ^(2)检验、Fisher确切概率法。结果术后1 d,观察组QoR-15评分为(103.66±10.16)分,高于对照组(91.86±10.12)分(t=6.074,P<0.001)。麻醉前,两组生命体征差异均无统计学意义(均P>0.05),麻醉后,两组生命体征各项指标均降低(均P<0.05),在切皮时,观察组HR为(66.86±6.63)次/min、SBP水平为(125.55±9.54)mmHg(1 mmHg=0.133 kPa)、DBP水平为(66.91±9.31)mmHg,均低于对照组(均P<0.05)。观察组术后1周MMSE评分为(25.66±1.08)分,与对照组(25.76±1.18)分比较差异无统计学意义(t=0.462,P=0.645)。观察组发生不良反应的概率为21.81%(12/55),较对照组18.51%(10/54)略高,但对比差异无统计学意义(P>0.05)。结论对接受CEA治疗的患者进行全身麻醉联合超声引导下浅丛神经阻滞效果较高,可降低其术中生命体征的波动幅度,不良反应风险不大,有利于术后恢复,且不会对认知功能造成更大影响,可在临床推广应用。

Objective To explore the effect of ultrasound-guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy(CEA)and its effect on postoperative Mini-Mental State Examination(MMSE)score and incidence of adverse reactions.Methods A total of 109 patients,with a male to female ratio of 66/43 and an age of(61.41±6.24)years old,who received CEA in Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2020 to April 2022 were retrospectively analyzed.According to different anesthesia plans,they were divided into a control group(54 cases)and an observation group(55 cases).The control group received preoperative general anesthesia,and the observation group received ultrasound-guided superficial cervical plexus block on the basis.The recovery[15-item Quality of Recovery Scale(QoR-15)],vital signs[heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)],cognitive function(MMSE score),and incidence of adverse reactions were compared between the two groups.All the data were imported into SPSS 21.0 software for processing,and t test,χ^(2) test,and Fisher exact probability method were used.Results One day after surgery,the QoR-15 score of the observation group was(103.66±10.16),which was higher than that of the control group(91.86±10.12)(t=6.074,P<0.001).Before anesthesia,there were no statistically significant differences in the vital signs between the two groups(all P>0.05);after anesthesia,the vital signs of the two groups were decreased(all P<0.05);during skin cutting,the HR,SBP,and DBP levels in the observation group were(66.86±6.63)times/min,(125.55±9.54)mmHg(1 mmHg=0.133 kPa),and(66.91±9.31)mmHg,which were lower than those in the control group(all P<0.05).The MMSE score of the observation group was(25.66±1.08)1 week after surgery,and there was no statistically significant difference compared with that of the control group(25.76±1.18)(t=0.462,P=0.645).The incidence of adverse reactions in the observation group was 21.81%(12/55),which was slightly higher than 18.51%(10/54)in the control group,but the difference was not statistically significant(P>0.05).Conclusion General anesthesia combined with ultrasound-guided superficial cervical plexus block for patients receiving CEA has a higher effect,which can reduce the fluctuation of intraoperative vital signs,has a greater impact on the cognitive function,and can be applied in clinical practice.