本文選題：頸動脈內(nèi)膜切除術(shù) + 頸淺叢神經(jīng)阻滯��； 參考：《第二軍醫(yī)大學(xué)學(xué)報》2017年05期

【摘要】：目的探究超聲引導(dǎo)下頸淺叢神經(jīng)阻滯復(fù)合全麻在頸動脈內(nèi)膜斑塊切除術(shù)(CEA)中的安全性及有效性。方法選擇40例擬擇期行CEA患者,依據(jù)麻醉方法分為超聲引導(dǎo)下頸淺叢神經(jīng)阻滯復(fù)合全麻組(復(fù)合全麻組)和單純?nèi)榻M,各20例。比較分析兩組在入手術(shù)室后或頸淺叢神經(jīng)阻滯前(T0-B)、頸淺叢神經(jīng)阻滯后(T_(0-L))、誘導(dǎo)后(T_1)、切皮時刻(T_2)、動脈剝離時刻(T_3)、頸動脈阻斷時刻(T_4)、頸動脈開放時刻(T_5)、術(shù)后2 h(T_6)的血流動力學(xué)(有創(chuàng)動脈壓及心率)和腦氧飽和度;術(shù)中麻醉藥和血管活性藥用量;術(shù)后視覺模擬評分(VAS)和術(shù)前、術(shù)后1 d及術(shù)后3 d的簡易精神狀態(tài)檢查(MMSE)評分。結(jié)果兩組患者間一般情況差異無統(tǒng)計學(xué)意義(P0.05)。單純?nèi)榻M的收縮壓在T_2、T_3時間點較T1時間點升高(P0.01),其舒張壓、平均動脈壓和心率在T_2時間點也均較T1時間點升高(P0.01)。除術(shù)側(cè)T_4時間點,兩組雙側(cè)腦氧飽和度在其他時刻均較T_(0-B)時間點升高,但差異無統(tǒng)計學(xué)意義(P0.05)。與單純?nèi)榻M比較,復(fù)合全麻組的麻醉藥用量、血管活性藥使用次數(shù)及VAS評分均降低(P0.05,P0.01),兩組間MMSE評分的差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論在CEA中,超聲引導(dǎo)下頸淺叢神經(jīng)阻滯復(fù)合全麻較單純?nèi)橛懈玫难鲃恿W(xué)及鎮(zhèn)痛狀態(tài),并減少了麻醉藥和血管活性藥的使用。
[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.
【作者單位】： 第二軍醫(yī)大學(xué)長征醫(yī)院麻醉科;
【基金】：上海市科委科研基金(17XD1424300)~~
【分類號】：R614

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