左旋布比卡因联合右美托咪定行头皮神经阻滞对开颅手术患者镇痛效果的研究

Analgesic efficacy of levobupivacaine combined with dexmedetomidine for scalp nerve block in craniotomy patients

目的探讨左旋布比卡因联合右美托咪定行头皮神经阻滞(SNB)对开颅手术患者镇痛的有效性。方法选取2021年2月至2023年2月浙江省丽水市中心医院收治的210例行开颅手术患者为研究对象,根据用药方法将其分为左旋布比卡因联合右美托咪定SNB复合全身麻醉组(LD组)70例,左旋布比卡因SNB复合全身麻醉(L组)70例,与常规全身麻醉组(G组)70例。比较3组的术后疼痛情况、血流动力学、应激水平和不良反应。结果3组术后各时间段视觉模拟评分(VAS)比较,L组、LD组均低于G组,且LD组低于L组(P<0.05)。与术前(T0)比较,3组切皮即刻(T1)、切皮后5 min(T2)、缝皮结束即刻(T3)及苏醒拔管时(T4)平均动脉压、心率均出现明显波动(P<0.05);L组、LD组T1、T2、T3、T4平均动脉压、心率波动幅度较G组小(P<0.05),LD组T1、T2、T3、T4平均动脉压、心率波动幅度较L组小(P<0.05)。3组应激反应指标比较,L组、LD组苏醒拔管时、术后24 h去甲肾上腺素(NE)、皮质醇(Cor)、肾上腺素(EP)水平较G组低(P<0.05);LD组苏醒拔管时、术后24 h EP、NE、Cor水平较L组低(P<0.05)。3组总不良反应发生率比较(26%、13%与14%),差异无统计学意义(χ^(2)=4.790,P=0.091)。结论左旋布比卡因联合右美托咪定行SNB可缓解开颅手术患者术后疼痛,减轻机体应激水平,改善血流动力学,且安全性较高。

Objective To investigate the analgesic efficacy of levobupivacaine and dexmedetomidine for scalp nerve block(SNB)patients undergoing craniotomy.Methods A total of 210 patients undergoing craniotomy admitted to Lishui Central Hospital from February 2021 to February 2023 were selected as the study subjects.With different treatment methods,they were divided into three groups:SNB with L-bupivacaine and dexmedetomi-dine under general anesthesia group(LD group)of 70 cases,SNB with L-Bupivacaine under general anesthesia group(L group)of 70 cases,and conventional general anesthesia group(G group)of 70 cases.Compare the post-operative pain,hemodynamics,stress response,and adverse reactions among the three groups.Results Compared the visu-al analogue scale(VAS)scores of the three groups at various time points after surgery.The scores of Group L and Group LD were lower than those of Group G,and the scores of Group LD were lower than those of Group L(P<0.05).Compared with preoperative(T0),there were significant fluctuations in mean arterial pressure and heart rate in the three groups immediately after skin removal(T1),5 minutes after skin removal(T2),immedi-ately after the sewing is completed(T3),and at the time of awakening and extubation(T4)(P<0.05).The mean ar-terial pressure and heart rate fluctuation amplitude of T1,T2,T3,and T4 in group L and LD were significantly smaller than those in group G(P<0.05),while the mean arterial pressure and heart rate fluctuation amplitude of T1,T2,T3,and T4 in group LD were significantly smaller than those in group L(P<0.05).In the comparison of three sets of stress response indicators,the levels of cortisol(Cor),norepinephrine(NE),and epinephrine(EP)dur-ing extubation and 24 hours after surgery in the L and LD groups were significantly lower than those in the G group(P<0.05).Moreover,the levels of EP,NE,and Cor in the LD group were significantly lower than those in the L group at the time of extubation and 24 hours after surgery(P<0.05).There was no significant difference in the total incidence of adverse reactions among the three groups(25.71%vs 12.86%vs 14.29%)(χ^(2)=4.790,P=0.091).Conclusion Levobupivacaine combined with dexmedetomidine for SNB can alleviate postoperative pain,alleviate stress levels,improve hemodynamics,and have high safety in patients undergoing craniotomy.