0.5%罗哌卡因头皮神经阻滞在开颅手术中的效果分析

Analysis of the Effect of 0.5%Ropivacaine Scalp Nerve Block in Craniotomy Surgery

目的研究开颅手术中实施0.5%罗哌卡因头皮神经阻滞对患者术后炎症因子、血流动力学及镇痛效果的影响。方法回顾性分析2020年1月—2023年1月在盐城市第一人民医院行开颅手术的86例患者的临床资料。按照麻醉药物不同对患者进行分组,即参照组43例、试验组43例。参照组实施1%利多卡因头皮神经阻滞,试验组实施0.5%罗哌卡因头皮神经阻滞。对2组患者不同时间炎症因子、血流动力学、镇痛效果及不良发应予以比较。结果2组术后6、24、48 h的C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin 6,IL-6)水平高于术前,白细胞介素-10(interleukin 10,IL-10)水平低于术前,差异有统计学意义(P<0.05);试验组术后6、24、48、72 h的CRP、IL-6水平低于参照组,IL-10水平高于参照组,差异有统计学意义(P<0.05)。2组切皮即刻(T1)、开颅时(T2)、缝合时(T3)的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)高于诱导前(T0),差异有统计学意义(P<0.05);试验组T1、T2、T3的HR、MAP低于参照组,差异有统计学意义(P<0.05)。试验组术后2、4、8、12 h疼痛评分低于参照组,差异有统计学意义(P<0.05)。试验组不良反应总发生率为6.98%,低于参照组的23.26%,差异有统计学意义(P<0.05)。结论开颅手术中实施0.5%罗哌卡因头皮神经阻滞可有效减轻患者术后炎症反应,改善血流动力学,缓解疼痛,降低不良反应发生率。

Objective To study the effect of scalp nerve block with 0.5%ropivacaine on postoperative inflammatory factors,hemodynamics and analgesic effect in patients undergoing craniotomy.Methods The clinical data of 86 patients who underwent craniotomy in Yancheng NO.1 People's Hospital from January 2020 to January 2023 were retrospectively analyzed..Patients were grouped according to different narcotic,namely,43 cases in the reference group and 43 cases in the test group.1%lidocaine scalp nerve block was performed in the reference group,and scalp nerve block with 0.5%ropivacaine was carried out in the test group.Inflammatory factors,hemodynamics,analgesic effects and adverse events of the two groups of patients at different times should be compared.Results The levels of C-reactive protein(CRP)and interleukin-6(IL-6)in 2 groups at 6,24 and 48 h after operation were higher than those before operation,and the levels of interleuin 10(IL-10)were lower than those before operation,the difference was statistically significant(P<0.05).The levels of CRP and IL-6 in test groups were lower than those in reference group at 6,24,48 and 72 h after operation,and the levels of IL-10 were higher than those in reference group,the differences were statistically significant(P<0.05).The heart rate(HR)and mean arterial pressure(MAP)of the 2 groups immediately after skin resection(T1),at craniotomy(T2)and suture(T3)were higher than those before induction(T0),and the differences were statistically significant(P<0.05).HR and MAP of T1,T2 and T3 in test groups were lower than those in reference group,and the differences were statistically significant(P<0.05).The pain scores of test groups at 2,4,8 and 12 h after operation were lower than those of the reference group,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions in test group was 6.98%,lower than 23.26%in reference group,the difference was statistically significant(P<0.05).Conclusion Cephalic nerve block with 0.5%ropivacaine in craniotomy can effectively reduce postoperative inflammatory reaction,improve hemodynamics,relieve pain,and reduce the incidence of adverse reactions.