头皮神经阻滞联合瑞芬太尼靶控输注在小儿开颅手术麻醉中的应用

发布时间：2018-03-17 15:20

本文选题：神经传导阻滞　切入点：神经外科手术　出处：《临床小儿外科杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的探讨头皮神经阻滞技术联合瑞芬太尼靶控输注在小儿神经外科麻醉中的应用。方法选择30例择期行颅内占位手术的患儿,按随机数字表法分为罗哌卡因神经阻滞组(B组)和对照组(C组),每组15例。常规麻醉诱导行气管插管后,B组于诱导后以0.25%罗哌卡因阻滞耳颞神经、眶上神经、滑车上神经和枕大神经、枕小神经,C组不进行神经阻滞。用丙泊酚和瑞芬太尼靶控输注维持麻醉。记录不同时间点的心率、平均动脉压、脑电双频指数(BIS),以及丙泊酚与瑞芬太尼使用总量、拔管时间,术后4、8、24、48 h疼痛视觉模拟评分(VAS),术后麻醉并发症。结果两组患者术中血流动力学均稳定,B组瑞芬太尼总量[(3.52±1.75)μg/(kg·h)]与C组[(6.54±1.23)μg/(kg·h)比较,差异有统计学意义(P0.01)。两组拔管时间[C组(10.01±8.47)min vs B组(8.35±7.17)min]、丙泊酚使用总量[C组(3.28±1.05)mg/(kg·h)vs B组(3.61±1.29)mg/(kg·h)]及术后并发症的发生率比较,差异均无统计学意义(P0.05)。两组术后4 h和8 h VAS评分比较,差异均有统计学意义(P0.01)。结论头皮神经阻滞技术联合瑞芬太尼靶控输注可减少小儿颅脑手术中瑞芬太尼用量,术后镇痛效果良好。
[Abstract]:Objective to investigate the application of scalp nerve block combined with remifentanil target-controlled infusion in pediatric neurosurgery anesthesia. The rats were randomly divided into ropivacaine block group (n = 15) and control group (n = 15). Group B was treated with 0.25% ropivacaine to block auricular nerve and supraorbital nerve after induction of tracheal intubation. The superior trochlear nerve, the greater occipital nerve and the small occipital nerve group C were not subjected to nerve block. Anesthesia was maintained by target-controlled infusion of propofol and remifentanil. Heart rate and mean arterial pressure were recorded at different time points. The bispectral index of EEG, the total amount of propofol and remifentanil, the time of extubation, The visual analogue score of pain was assessed at 48 h after operation. Results the hemodynamics of group B was stable [3.52 卤1.75 渭 g / kg 路h] and that of group C [6.54 卤1.23 渭 g / kg 路h], and that of group C was higher than that of group C (6.54 卤1.23) 渭 g / kg 路h. There was significant difference in extubation time (10.01 卤8.47 min vs 8.35 卤7.17 min in group C vs 8.35 卤7.17 min in group B), total use of propofol [3.28 卤1.05 mg / kg 路h in group C vs 3.61 卤1.29 mg / kg 路h] and incidence of postoperative complications. There was no significant difference in the incidence of postoperative complications between the two groups. Conclusion the technique of scalp nerve block combined with remifentanil target controlled infusion can reduce the dosage of remifentanil in pediatric craniocerebral surgery and the postoperative analgesia effect is good.
【作者单位】：湖南省人民医院麻醉科;中南大学湘雅医院麻醉科;
【分类号】：R726.1

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