超声引导下颈浅丛神经阻滞复合全麻与单纯全麻在颈动脉内膜斑块切除术中的比较

发布时间：2018-05-12 20:56

本文选题：颈动脉内膜切除术 + 颈浅丛神经阻滞　；参考：《第二军医大学学报》2017年05期

【摘要】：目的探究超声引导下颈浅丛神经阻滞复合全麻在颈动脉内膜斑块切除术(CEA)中的安全性及有效性。方法选择40例拟择期行CEA患者,依据麻醉方法分为超声引导下颈浅丛神经阻滞复合全麻组(复合全麻组)和单纯全麻组,各20例。比较分析两组在入手术室后或颈浅丛神经阻滞前(T0-B)、颈浅丛神经阻滞后(T_(0-L))、诱导后(T_1)、切皮时刻(T_2)、动脉剥离时刻(T_3)、颈动脉阻断时刻(T_4)、颈动脉开放时刻(T_5)、术后2 h(T_6)的血流动力学(有创动脉压及心率)和脑氧饱和度;术中麻醉药和血管活性药用量;术后视觉模拟评分(VAS)和术前、术后1 d及术后3 d的简易精神状态检查(MMSE)评分。结果两组患者间一般情况差异无统计学意义(P0.05)。单纯全麻组的收缩压在T_2、T_3时间点较T1时间点升高(P0.01),其舒张压、平均动脉压和心率在T_2时间点也均较T1时间点升高(P0.01)。除术侧T_4时间点,两组双侧脑氧饱和度在其他时刻均较T_(0-B)时间点升高,但差异无统计学意义(P0.05)。与单纯全麻组比较,复合全麻组的麻醉药用量、血管活性药使用次数及VAS评分均降低(P0.05,P0.01),两组间MMSE评分的差异无统计学意义(P0.05)。结论在CEA中,超声引导下颈浅丛神经阻滞复合全麻较单纯全麻有更好的血流动力学及镇痛状态,并减少了麻醉药和血管活性药的使用。
[Abstract]:Objective to investigate the safety and efficacy of ultrasound guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy. Methods 40 patients with CEA were selected and divided into two groups according to the anesthetic method: the combined general anesthesia group (combined general anesthesia group) and the simple general anesthesia group (20 cases) under ultrasound guided superficial cervical plexus nerve block. The blood flow of the two groups was compared after operation room or before cervical superficial plexus nerve block, after superficial cervical plexus nerve block, after induction, T 1, T 2, T 3, T 4, T 5, T 5, 2 h after operation). Dynamic (invasive arterial pressure and heart rate) and cerebral oxygen saturation; The dosage of anesthetics and vasoactive drugs during operation, visual analogue score (VASs) and MMSE scores before operation, 1 day after operation and 3 days after operation. Results there was no significant difference in general conditions between the two groups (P 0.05). The systolic blood pressure of simple general anesthesia group was higher than that of T 1 time point at T _ 2 / T _ 3. The diastolic blood pressure, mean arterial pressure and heart rate were also increased at T _ 2 time point compared with T _ 1 time point. The bilateral cerebral oxygen saturation in both groups increased at other time points, but there was no significant difference between the two groups (P 0.05). Compared with the general anesthesia group, the dosage of anesthetic, the number of times of using vasoactive drugs and the VAS score of the combined general anesthesia group were lower than that of the simple general anesthesia group, and the difference of the MMSE score between the two groups was not statistically significant (P 0.05). Conclusion Ultrasound-guided superficial cervical plexus block combined with general anesthesia has better hemodynamics and analgesia than general anesthesia alone and reduces the use of anesthetics and vasoactive drugs in CEA.
【作者单位】：第二军医大学长征医院麻醉科;
【基金】：上海市科委科研基金(17XD1424300)~~
【分类号】：R614

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