临床外科杂志 ›› 2019, Vol. 27 ›› Issue (12): 1074-1076.doi: 10.3969/j.issn.1005-6483.2019.12.019

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右美托咪定不同给药途径复合头皮神经阻滞对围术期血流动力学和应激反应的影响

  

  1. 430022 武汉,华中科技大学同济医学院附属协和医院麻醉科
  • 出版日期:2019-12-20 发布日期:2019-12-20
  • 通讯作者: 姚尚龙,Email:ysltian@163.com

Effects of different administration of dexmedetomidine combined with scalp nerve block on perioperative hemodynamics and stress response

  1. Department of Anesthesiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China
  • Online:2019-12-20 Published:2019-12-20

摘要:

目的 观察右美托咪定(DEX)神经周围注射与静脉应用复合头皮神经阻滞对围术期血流动力学及应激反应的影响。方法 择期颅内动脉瘤手术病人50例。采用随机数字表法随机分为两组,每组25例,A组采用DEX 1μg/kg静脉注射,B组采用DEX 1μg/kg混合罗哌卡因头皮神经阻滞。两组病人入室后超声引导下行双侧头皮神经阻滞,之后常规全麻诱导气管插管。记录病人诱导前(T0)、插管后5分钟(T1)、切皮时(T2)、锯颅骨时(T3)、手术结束时(T4)的平均动脉压(MAP)、心率(HR),记录T0、T2和术后6小时(T5)的血皮质醇水平,记录术中丙泊酚、瑞芬的用量,记录病人的镇痛持续时间和需补救镇痛例数。结果 两组病人T1~T4各时间点的MAP均低于T0时水平,A组病人T1~T4各时间点的HR均较T0时下降,B组病人的HR只在T1、T4这两个时点低于T0时水平,差异均有统计学意义(P<0.05);B组病人T1、T2两时点的MAP和T1、T2和T3等时点的HR水平与A组比较,差异有统计学意义(P<0.05)。两组病人T2、T5两时点的血皮质醇均较T0时水平升高,差异有统计学意义(P<0.05);A组和B组病人T5时点皮质醇水平分别为429.4nmol/L、378.6nmol/L,B组较之A组病人的血皮质醇显著降低(P<0.05)。A组和B组病人术后镇痛持续时间分别为652.8min、736.4min,B组较之A组病人术后镇痛持续时间更长(P<0.05);B组仅有1位病人需补救镇痛,较A组显著减少(P<0.05)。结论 与静脉应用相比,DEX神经周围注射复合头皮神经阻滞能使血流动力学更平稳,延长术后镇痛时长,可减轻围术期应激反应。

关键词: 右美托咪定, 头皮神经阻滞, 血流动力学, 应激反应

Abstract: Objective To observe the effects of perineural and intravenous dexmedetomidine injection combined with scalp nerve block on perioperative hemodynamics and stress response.Methods Elective intracranial aneurysm surgery for 50 patients,which were randomly divided into two groups(n=25):DEX 1ug/kg intravenous injection group(group A)and DEX 1ug/kg mixed with ropivacaine perineural group(group B).Patients in both groups were treated with bilateral scalp nerve block guided by ultrasound.Endotracheal intubation was performed after general anesthesia induction.Mean arterial pressure(MAP)and heart rate(HR)at pre-induction(T0),5min after intubation(T1),incision(T2),sawing skulls(T3)and the end of surgery(T4)were recorded,blood cortisol levels at T0,T2 and 6h after surgery(T5)were recorded.Intraoperative propofol and remifentanil consumption、duration of analgesia and number of patients requiring rescue analgesia were recorded.Results The MAP of T1 ~ T4 in both groups was lower than that at T0.In group A,HR at all time points from T1 to T4 decreased compared with that at T0,HR in group B was only lower than T0 at T1 and T4(P<0.05).MAP at T1,T2 and HR at T1,T2,T3 in group B were statistically different from those in group A(P<0.05).Blood cortisol level at T5 in group B(378.6nmol/L)was significantly decreased compared with group A(429.4nmol/L)(P<0.05).Duration of postoperative analgesia in group B(736.4min)was prolonged compared with group A(652.8min),while only one patient in group B needed relief compared with group A.(both P<0.05).Conclusion Compared with intravenous administration,perineural dexmedetomidine combined with scalp nerve block can stabilize hemodynamics,prolong postoperative analgesia duration and reduce perioperative stress response.

Key words: dexmedetomidine, scalp nerve block, hemodynamics, stress response

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