[1]朱艺霞,王明虹.超声引导下头部周围神经阻滞在开颅手术中的应用[J].福建医药杂志,2021,43(02):18-21.
　ZHU Yixia,WANG Minghong.Application of ultrasound-guided peripheral nerve block in craniotomy[J].FUJIAN MEDICAL JOURNAL,2021,43(02):18-21.
点击复制

超声引导下头部周围神经阻滞在开颅手术中的应用()
分享到：

《福建医药杂志》[ISSN:1002-2600/CN:35-1071/R]

卷:
43
期数:
2021年02期
页码:
18-21
栏目:
临床研究
出版日期:
2021-04-15

文章信息/Info

Title:
Application of ultrasound-guided peripheral nerve block in craniotomy
文章编号:
1002-2600(2021)02-0018-04
作者:
朱艺霞; 王明虹
福建医科大学附属宁德市医院麻醉科(宁德 352100)
Author(s):
ZHU Yixia;  WANG Minghong
Department of Anesthesiology,Ningde Hospital Affiliated to Fujian Medical University,Ningde,Fujian 352100,China
关键词:
超声;  头部周围神经阻滞;  开颅;  血流动力学;  应激反应
Keywords:
ultrasound;  peripheral nerve block;  craniotomy;  hemodynamics;  stress response
分类号:
R614
文献标志码:
B
摘要:
目的 通过观察超声引导下头部周围神经阻滞对开颅手术患者血流动力学、应激反应的影响,探讨其临床价值。方法 60例颅内占位患者随机分为两组,对照组30例采取全身麻醉,观察组30例于全身麻醉前行超声引导下头部周围神经阻滞。比较两组术中不同时间点心率、平均动脉压水平,并测定血浆皮质醇、血管紧张素Ⅱ、血糖水平评估应激反应,统计两组术中麻醉药物丙泊酚、镇痛药物使用总量及不良反应发生情况。结果 同组内与T0比较,T2、T3、T4时刻观察组MAP、HR水平差异无统计学意义(P>0.05),对照组MAP、HR水平升高(P<0.05); 与观察组比较,对照组T2、T3、T4时刻MAP、HR水平升高(P<0.05)。同组内与T0比较,观察组T1、T2、T3、T4时刻皮质醇、血管紧张素Ⅱ水平均降低(均P<0.05); 与对照组比较,观察组T2、T3、T4时刻皮质醇、血管紧张素Ⅱ、血糖水平均降低(均P<0.05)。两组手术时间比较差异无统计学意义(P>0.05); 观察组丙泊酚及瑞芬太尼使用总量均低于对照组(均P<0.05); 观察组术中不良反应发生率低于对照组(P<0.05)。结论 超声引导下头部周围神经阻滞有助于维持开颅手术患者血流动力学稳定,并减轻应激反应,减少不良反应。
Abstract:
Objective To investigate the clinical value of ultrasound-guided peripheral nerve block on hemodynamics and stress response in patients undergoing craniotomy.Methods A total of 60 patients with intracranial space occupying were randomly divided into two groups, 30 patients in the control group received general anesthesia, and 30 patients in the observation group received ultrasound-guided peripheral head nerve block before general anesthesia.The heart rate and average arterial pressure at different time points in the two groups were compared, and the plasma cortisol, angiotensin Ⅱ and blood glucose levels were measured to assess the stress response.The total amount of anesthetic propofol and analgesic drugs used and the occurrence of adverse reactions in the two groups were calculated.Results Compared with T0 in the same group, there was no statistically significant difference in MAP and HR levels of the observation groups at T2, T3 and T4(P<0.05),and the levels of MAP and HR in the control group increased(P<0.05); Compared with the observation group, the levels of MAP and HR in the control group increased at T2, T3 and T4(P<0.05).In the observation group, cortisol and angiotensin Ⅱ levels were all reduced at T1, T2, T3 and T4 compared with those at T0(P<0.05); Compared with the control group, cortisol, angiotensin Ⅱ and blood glucose levels in the observation group were all reduced at T2, T3 and T4(P<0.05).There was no significant difference in operation time between the two groups(P<0.05).The total amounts of propofol and remifentanil in the observation group were lower than those in the control group(P<0.05).The incidence of intraoperative adverse reactions in the observation group was lower than that in the control group(P<0.05). Conclusion Ultrasound-guided peripheral nerve block is helpful to maintain hemodynamic stability in patients undergoing craniotomy, reduce stress response and adverse reactions.

参考文献/References:

[1] 侯新冉,谢咏秋,郭曲练,等.成人开颅手术术后疼痛现状及治疗进展[J].临床麻醉学杂志,2017,33(5):512-515.
[2] 韩铖琛,杨帆,魏铂沅,等.塞来昔布联合布比卡因控制开颅手术术后疼痛的研究[J].徐州医学院学报,2017,37(5):312-314.
[3] Chowdhury T,Baron K,Cappellani R B,et al.Severe bradycardia during scalp nerve block in patient undergoing awake craniotomy[J].Saudi J Anaesth,2013,7(3):356-357.
[4] 张永燕,许华.神经外科围术期多模式镇痛治疗研究进展[J].临床麻醉学杂志,2017,33(5):515-518.
[5] 詹峰.氟比洛芬酯预处理对开颅手术患者术中血流动力学及术后疼痛的影响[J].福建医药杂志,2019,41(2):40-43.
[6] 庞德春,廖振南,梁琛,等.头部周围神经阻滞联合全麻在颅脑手术中的应用[J].广西医科大学学报,2015,32(4):596-599.
[7] 杨燕琳,陈光强,何璇,等.危重患者疼痛观察工具在颅脑肿瘤开颅术后疼痛评估中的应用[J].首都医科大学学报,2019,40(5):758-763.
[8] 金海龙,申颖,孟岚,等.神经阻滞治疗开颅术后重度颅外神经痛的效果:33例回顾性分析[J].中华麻醉学杂志,2017,37(11):1326-1328.
[9] 张佩,杨静.开颅手术后镇痛的研究进展[J].临床麻醉学杂志,2018,34(3):308-310.
[10] 周珩,邓娜,梁佐迪,等.头皮神经阻滞在颅脑外科术后镇痛中应用[J].临床军医杂志,2017,45(11):1138-1140.
[11] 阮义峰,曾琼,陆军,等.帕瑞昔布钠用于神经外科术后镇痛的临床效果[J].江苏医药,2017,43(24):1832-1833.
[12] 王纲,王颖晨.头部神经阻滞对全麻下神经外科上头架和开颅期血流动力学及血糖的影响[J].实用医学杂志,2009,25(8):1223-1224.

相似文献/References:

[1]尹冠群,曾艳,周戎君,等.超声光散射成像对乳腺肿瘤诊断价值分析[J].福建医药杂志,2017,39(4):127.
[2]卢希,林树英,林芩,等.超声引导下喉上神经内支阻滞对喉罩全麻后咽喉痛的影响[J].福建医药杂志,2017,39(4):137.
[3]郑婉静,陈国忠.围术期超声引导下星状神经节阻滞的研究进展[J].福建医药杂志,2017,39(4):155.
[4]聂立雄 邱全明 张其旺 吴晓丹.罗哌卡因复合右美托咪定用于腹横肌平面阻滞对剖宫产术后静脉镇痛效果的影响[J].福建医药杂志,2017,39(5):29.
[5]李学山.超声引导下腰丛坐骨神经阻滞在髋关节置换术的应用效果观察[J].福建医药杂志,2017,39(5):75.
[6]陈琳.超声引导下肌间沟臂丛神经阻滞在上肢清创手术中的应用[J].福建医药杂志,2017,39(5):111.
[7]吴道明 朱 琳 林 芸 张丽华 吴松松 林 宁.光散射成像预测乳腺浸润性癌腋窝淋巴结转移的作用[J].福建医药杂志,2019,41(05):16.
　WU Daoming,ZHU Lin,LIN Yun,et al.Assessing prediction of axillary lymph node status in invasive breast carcinoma by using diffuse optical tomography[J].FUJIAN MEDICAL JOURNAL,2019,41(02):16.
[8]邱秀萍,张志承,黄汝哨,等.超声引导下甲状腺囊肿聚桂醇硬化治疗40例效果分析[J].福建医药杂志,2021,43(01):77.
[9]涂文劭,郑艇,陈江湖,等.术前超声引导髂筋膜间隙阻滞持续镇痛在老年髋部骨折患者中的应用[J].福建医药杂志,2021,43(03):4.
　TU Wenshao,ZHENG Ting,CHEN Jianghu,et al.Application of preoperative ultrasound-guided fascia iliaca compartment block for continuous analgesia in elderly patients with hip fracture[J].FUJIAN MEDICAL JOURNAL,2021,43(02):4.
[10]黄洁,王翠兰.染色体微阵列分析技术在超声异常胎儿产前遗传学诊断中的应用价值[J].福建医药杂志,2022,44(04):5.
　HUANG Jie,WANG Cuilan.Application value of chromosome microarray analysis in prenatal genetic diagnosis of abnormal fetus detected by ultrasound[J].FUJIAN MEDICAL JOURNAL,2022,44(02):5.

更新日期/Last Update: 2021-04-15