头皮神经阻滞辅助全身麻醉对颅内占位手术患者应激反应及生命体征的影响

Effect of Scalp Nerve Block-assisted General Anesthesia on Stress Response and Vital Signs in Patients Undergoing Intracranial Space-occupying Surgery

【目的】探讨头皮神经阻滞辅助全身麻醉对颅内占位手术患者应激反应及生命体征的影响。【方法】将在本院择期行颅内占位手术的90例患者随机分为观察组和对照组,每组45例。对照组行全身麻醉,观察组实施头皮神经阻滞辅助全身麻醉。比较两组手术麻醉诱导前(T_(0))、上头架(T_(1))、切皮(T_(2))、骨膜分离(T_(3))、去骨瓣(T_(4))、术中(T_(5))、缝皮(T_(6))、拔管(T_(7))等关键时间点的生命体征[舒张压(DBP)、收缩压(SBP)、心率(HR)]及机体应激因子[多巴胺(DA)、肾上腺素(A)、去甲肾上腺素(NE)]水平,并记录两组麻醉药物使用量。【结果】两组T_(0)、T_(4)、T_(5)时DBP、SBP、HR比较,差异均无统计学意义(P>0.05);观察组T_(1)、T_(6)、T_(7)时DBP、SBP、HR低于对照组,T_(2)时DBP低于对照组,T_(3)时HR低于对照组,且差异有统计学意义(P<0.05);两组T_(2)时SBP、HR以及T_(3)时SBP、DBP比较,差异均无统计学意义(P>0.05);两组T_(0)时血清DA、A、NE水平比较,差异无统计学意义(P>0.05),观察组T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)、T_(7)时血清DA、A、NE水平低于对照组,且差异有统计学意义(P<0.05)。观察组瑞芬太尼用量为(2.24±1.60)mg,低于对照组的(4.72±1.52)mg(P<0.05);两组丙泊酚用量比较,差异无统计学意义(P>0.05)。【结论】头皮神经阻滞辅助全身麻醉能更好地维持颅内占位手术患者生命体征稳定,缓解机体应激反应,减少全麻镇痛药物使用量。

【Objective】To investigate the effect of scalp nerve block-assisted general anesthesia on stress response and vital signs in patients undergoing Intracranial space-occupying operation.【Methods】A total of 90 patients undergoing elective intracranial space-occupying operation in our hospital were randomly divided into two groups:the 45 patients in the control group underwent general anesthesia and the other 45 patients in the observation group underwent scalp nerve block-assisted general anesthesia.Vital signs such as diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)and serum dopamine(DA),adrenaline(A),noradrenaline(NE)were compared between the two groups at different time points:before anesthesia induction(T_(0)),upper head frame placement(T_(1)),skin incision(T_(2)),periosteal separation(T_(3)),bone flap/craniectomy(T_(4)),intraoperative(T_(5)),skin suture(T_(6)),extubation(T_(7)).and other body stress factor levels and the usage of drug doses in the two groups was recorded.【Results】There were no significant differences in DBP,SBP and HR between the two groups at T_(0),T_(4),and T_(5)(P>0.05);While the DBP,SBP,HR at T_(1),T_(6),and T_(7) in the observation group were lower those in the control group;the DBP of the observation group at T_(2) was lower than that of the control group,and HR at T_(3) in the observation group was lower than that in the control group(P<0.05).There were no significant differences between the two groups in terms of SBP and HR at T_(2) plus SBP and DBP at T_(3)(P>0.05).There were no significant differences in serum DA,A and NE levels between the two groups at T_(0)(P>0.05).The serum DA,A and NE levels of the observation group were lower than those of the control group at T_(1),T_(2),T_(3),T_(4),T_(5),T_(6) and T_(7);And the differences were statistically significant(P<0.05).The remifentanil doses in the observation group and the control group were(2.24±1.60)mg and(4.72±1.52)mg,respectively,with statistically significant difference between the two groups(P<0.05).There was no significant difference of the propofol usage between the two groups(P>0.05).【Conclusion】Scalp nerve block-assisted general anesthesia can better maintain the stability of vital signs during Intracranial space-occupying operation,relieve the relieve body stress and reduce the usage of general analgesics.