头皮神经阻滞复合全麻用于合并高血压患者开颅手术的研究

General anesthesia combined scalp nerve block used in craniotomy for patients with hypertension

摘要:

目的：探讨头皮神经阻滞复合全身麻醉用于术前合并高血压患者的开颅手术，观察其循环的稳定性。探讨头皮神经阻滞复合全麻能否有助于开颅手术的安全性，能否降低二次手术的发生率。方法：将60例行开颅手术的患者随机分为全身麻醉组（对照组）和头皮神经阻滞复合全身麻醉组（实验组）。在实验组中，根据手术切口的范围，选择性阻滞眶上神经、耳颞神经、枕大、枕小神经。记录围手术期重要的生命体征、药物使用量、苏醒与拔管时间及相关并发症的发生率。结果：实验组的循环在围手术期更加平稳，波动较小。实验组丙泊酚（P=0.00）、舒芬太尼（P=0.00）及瑞芬太尼（P=0.00）的使用量低于对照组，其拔管时间（P=0.00）及苏醒时间（P=0.00）也相应缩短。实验组二次手术发生0例，对照组二次手术发生率为2例（P=0.492）。结论：头皮神经阻滞复合全麻能够更有效地维持开颅手术术中心率和血压的稳定，使患者能够早期恢复，可能降低二次手术的风险。

Abstract:

Objective：To investigate the scalp nerve block combined with general anesthesia used in craniotomy in patients with hyper－tension，to observe the circulation stability and to explore whether scalp nerve block combined with general anesthesia can reduce the incidence of secondary surgery. Methods：Totally 60 craniotomy patients were randomly divided into the general anesthesia group（control group） and scalp nerve block combined with general anesthesia group（experimental group）. In the experimental group，based on the scope of the incision，the supraorbital，nerve auriculotemporal nerve，greater occipital and lesser occipital selective were selectively blocked. Important vital signs，drug usage，awakening and extubation time and the incidence of related complications during the perioperative period were recorded. Results：Hemodynamic in scalp nerve group is more stable and less volatile during the perioperative period. Dosages propofol（P=0.00），sufentanil（P=0.00） and remifentanil（P=0.00） were higher in experimental group than in control group. Extubation time（P=0.00） and awakening time（P=0.00） were reduced in experimental group than in control group accordingly. Two patients experienced a second surgery in control group（P=0.492） but none in experimental group. Conclusions：Scalp nerve block can more effectively maintain intraoperative heart rate and blood pressure ,which may reduce the incidence of secondary surgery.