头皮神经阻滞联合右美托咪定泵注对幕上肿瘤切除术患者术后恢复质量的影响

Effect of scalp nerve block combined with dexmedetomidine injection on postoperative recovery quality in patients undergoing supratentorial tumor resection

目的 探讨头皮神经阻滞(SNB)联合右美托咪定(Dex)泵注对幕上肿瘤切除术患者术后早期恢复质量的影响。方法 采用析因设计,选择择期行幕上肿瘤切除术患者160例,随机分为对照组(C组)、头皮神经阻滞组(SNB组)、右美托咪定组(Dex组)和头皮神经阻滞联合右美托咪定组(SNB+Dex组),每组40例。记录术前1 d(D0)、术后1 d(D1)、3 d(D3)、7 d(D7)40项恢复质量量表(Qo R-40)评分;D0与D1时神经损伤标志物[S100β蛋白、胶质纤维酸性蛋白(GFAP)]血清浓度;记录术后24 h、48 h NRS评分,术后48 h内术后恶心呕吐发生率及镇痛药物使用率,术中不良事件发生率及血管活性药物使用率,拔管时呛咳及躁动发生率,术后住院时长。结果 D1、D3时SNB与Dex对QoR-40量表总评分的主效应及两因素交互作用显著(P <0.05);D7时两因素交互作用不显著(P> 0.05),SNB与Dex的主效应均显著(P <0.05)。血清S100β和GFAP浓度,D1时Dex主效应均显著(P <0.05),SNB主效应和两因素交互作用均不显著(P> 0.05)。SNB是术中高血压事件的保护因素(P <0.05),SNB与Dex是术中心动过速和术中血管活性药物使用,术后24 h与48 h NRS评分和术后补救镇痛事件保护因素(P <0.05),Dex是术后呛咳和躁动事件的保护因素(P <0.05)。术后48 h内术后恶心呕吐发生率及术后住院时间之间的差异无统计学意义(P> 0.05)。结论 SNB联合Dex泵注可以提高幕上肿瘤切除术患者术后早期QoR-40评分,降低术后神经损伤标志物浓度,减少围术期不良事件发生率,降低术后疼痛强度和镇痛药物使用率,促进术后早期恢复。

Objective To investigate the effect of scalp nerve block(SNB)combined with dexmedeto⁃midine(Dex)injection on postoperative recovery quality in patients undergoing supratentorial tumor resection.Methods Based on factorial trail design,160 patients who were scheduled for supratentorial tumor resection were randomly divided into four groups:control group(C group C),scalp nerve block group(SNB group),dexmedetomidine group(Dex group)and scalp nerve block combined with dexmedetomidine group(SNB+Dex group).Then,the 40⁃item Quality of Recovery Score(QoR40 score)was used to evaluate the recovery quality 1 day before operation(D0),and 1,3 and 7 d after operation(D1,D3 and D7).The serum concentration of markers of nerve injury[S100βprotein,glial fibrillary acid protein(GFAP)]was detected right and 24 h after operation.The two groups were compared as well in terms of the score by the numerical rating scale(NRS)24 h and 48 h after operation,frequency of analgesia,incidence of adverse events,use of vasoactive agents,incidence of coughing and agitation during extubation,nausea and vomiting(PONV)within 48 h after operation as well as the postoperative hospitaliza⁃tion stay.Results In D1 and D3,the interaction between SNB and Dex on total score of QoR⁃40 scale was signifi⁃cant(P<0.05),but the interaction between the two factors was not significantly at D7(P>0.05),and their main effects were significant(P<0.05).As for serum S100βand GFAP concentrations,the Dex main effect was significant at D1(P<0.05),and the SNB main effect and the two⁃factor interaction were not significant(P>0.05).The incidence of intraoperative hypertension,tachycardia,utilization rate of vasoactive drugs,coughing and agita⁃tion during extubation in SNB+Dex group were significantly lower than those in C group(P<0.05).The frequency of postoperative analgesic drugs in SNB group and SNB+Dex group was significantly lower than that in C group(P<0.05).The postoperative NRS score at 48 h of the other three groups was significantly lower than that of C group(P<0.05).There was no significant difference in the incidence of PONV and the length of hospitalization stay during 48 h after surgery(P>0.05).Conclusion SNB combined with Dex injection can improve the early postoperative QoR⁃40 score in patients undergoing supratentorial tumor resection,reduce the serum concentration of nerve injury markers,reduce the incidence of perioperative adverse events,alleviate postoperative pain,lower the use of analgesic drugs and improve the early postoperative recovery.