地佐辛超前镇痛联合头皮神经阻滞对血肿清除术治疗高血压脑出血患者的影响

Effect of dezocine preemptive analgesia combined with scalp nerve block on hematoma evacuation in patients with hypertensive intracerebral hemorrhage

目的分析地佐辛超前镇痛联合头皮神经阻滞(scalp nerve block,SNB)在高血压脑出血(hypertensive intracerebral hemorrhage,HICH)患者手术治疗的应用效果。方法 使用随机数表法将手术治疗的76例HICH患者均分为对照组和观察组。对照组在常规全身麻醉基础上给予SNB麻醉,观察组在对照组基础上给予地佐辛超前镇痛。比较两组术前、切皮、穿刺颅骨、缝皮时的平均动脉压(mean arterial pressure,MAP)、心率;比较两组清醒拔管时、术后6h、12h、24h、48h时的视觉模拟评分法(visual analogue scale,VAS)疼痛评分;统计两组麻醉相关不良反应发生率。结果 对照组切皮、穿刺颅骨、缝皮时的MAP、心率水平均高于术前,观察组切皮、穿刺颅骨、缝皮时的MAP、心率水平均低于对照组(P<0.001)。观察组术后6h、12h、24h、48h时的VAS评分均较对照组更低(P<0.001)。观察组不良反应发生率为5.26%,对照组为23.68%,观察组低于对照组(P<0.05)。结论 地佐辛超前镇痛联合SNB应用于HICH患者手术治疗,不仅可有效维持患者围术期血流动力学稳定,还可减轻患者术后疼痛,提高麻醉安全性。

Objective To analyze the effect of dezocine preemptive analgesia combined with scalp nerve block(SNB)in the surgical treatment of patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 76 HICH patients undergoing surgical treatment were randomly divided into a control group and an observation group using a random number table.The control group received SNB anesthesia on the basis of routine general anesthesia,while the observation group received dezocine preemptive analgesia in addition to the treatment given to the control group.The mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups at preoperative,skin incision,skull puncture and skin suture time points.Visual analogue scale(VAS)scores were compared between the two groups at the time of awake extubation,and 6,12,24,and 48 h postoperatively.The incidence of anesthesia-related adverse reactions was recorded for both groups.Results The MAP and HR levels in the control group were higher than preoperative levels during skin incision,skull puncture,and skin suture,while those in the observation group were lower than those in the control group during these periods(P<0.001).The VAS scores in the observation group were significantly lower at 6,12,24 and 48 h postoperatively(P<0.001).The incidence of adverse reactions was 5.26%in the observation group and 23.68%in the control group,indicating a lower rate in the observation group(P<0.05).Conclusions The application of dezocine preemptive analgesia combined with SNB in surgical treatment of HICH patients can effectively maintain perioperative hemodynamic stability,reduce postoperative pain,and improve anesthesia safety.