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2种不同麻醉方法在立体定向颅内血肿清除术中的麻醉效果比较
Comparison of two anesthesia methods for stereotactic evacuation of intracranial hematoma
- 保健医学研究与实践 2018年15卷第3期 页码：45-49
- 作者机构：
贵州医科大学附属医院麻醉科
- 作者简介：
- 基金信息：
DOI：
中图分类号： R614纸质出版日期：2018，
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[1]史静,蒋柯,钟毅,谭立,邹小华.2种不同麻醉方法在立体定向颅内血肿清除术中的麻醉效果比较[J].保健医学研究与实践,2018,15(03):45-49.
Shi Jing, Jiang Ke, Zhong Yi, et al. Comparison of two anesthesia methods for stereotactic evacuation of intracranial hematoma[J]. Health Medicine Research and Practice, 2018,15(3):45-49.
摘要
目的比较局部浸润麻醉和头皮神经阻滞麻醉在立体定向颅内血肿清除术中的麻醉效果。方法选取2017年6-12月在贵阳市某医院接受立体定向颅内血肿清除术治疗的60例自发性脑出血患者为研究对象。采用随机数字表法将患者分为研究组和对照组
每组30例。研究组患者采用头皮神经阻滞麻醉
对照组患者采用局部浸润麻醉。比较2组患者进入手术室时（T0）、麻醉实施10 min时（T
1
）、切头皮时（T
2
）、钻颅骨时（T
3
）、缝皮时（T
4
）、术后1h（T
5
）
术后6h（T
6
）的心率（HR）、平均动脉压（MAP）、呼吸频率（R）、血氧饱和度（SpO
2
）。比较2组患者T
0
、穿刺颅骨后2min（T
a
）、抽吸血肿完成后2min（T
b
）、T
5
和T
6
时点的血糖及皮质醇水平。比较2组患者T4时点的疼痛程度。比较2组患者术后再出血发生率及患者对手术的满意度。结果T
0
T
1
时点
2组患者HR
MAP比较
差异无统计学意义（P
>
0.05）。T
2
T
3
T
4
时点
2组患者HR
MAP均高于T0时点
且对照组患者HR
MAP高于研究组
差异均有统计学意义（P
<
0.05）。T
5
T
6
时点
对照组患者HR
MAP均高于T0时点
且对照组患者HR
MAP高于研究组
差异均有统计学意义（P
<
0.05）。不同时点2组患者R及SpO
2
比较
差异均无统计学意义（P
>
0.05）。T
0
时点
2组患者血糖及皮质醇水平比较
差异均无统计学意义（P
>
0.05）。T
a
T
b
T
5
T
6
时点
对照组患者血糖及皮质醇水平均高于T0时点
且对照组患者高于研究组
差异均有统计学意义（P
<
0.05）。研究组患者重度疼痛发生率低于对照组
差异均有统计学意义（P
<
0.05）。研究组患者手术满意度评分高于对照组
差异有统计学意义（P
<
0.05）。结论头皮神经阻滞麻醉在立体定向颅内血肿清除术中的麻醉效果优于局部浸润麻醉
其可减轻患者在术中的应激反应
提高手术舒适度及患者手术满意度。
Abstract
Objective To compare the anesthetic effects of local infiltration versus scalp nerve block for stereotactic evacuation of intracranial hematoma.Methods A total of 60 patients diagnosed with spontaneous intracerebral hemorrhage who underwent stereotactic evacuation of intracranial hematoma at a Guiyang hospital from June to December 2017 were included in this study.Using a random number table
these patients were divided into the trial group（scalp nerve block）and the control group（local infiltration）
30 patients in each group.The heart rate（HR）
mean arterial pressure（MAP）
respiratory rate（R）
and oxygen saturation（SpO
2
）at the entry of operating room（T
0
）
10 min after anesthesia induction（T
1
）
at scalp incision（T
2
）
at skull drilling（T
3
）
at suturing（T
4
）
1 hafter surgery（T
5
）
and 6 hafter surgery（T
6
）were compared between the two groups.Besides
the blood glucose and cortisol levels at T
0
2 min after skull puncture（Ta）
2 min after completion of hematoma aspiration（Tb）
at T
5
and T
6
;the pain intensity at T
4
;as well as the incidence of postoperative re-bleeding and patient satisfaction were also compared between the two groups.Results At T
0
and T
1
the HR and MAP were comparable between the two groups（P
>
0.05）.At T
2
T
3
and T
4
the HR and MAP were significantly increased compared with those at T
0
in both groups
but significantly greater increases were noted in the control group（P
<
0.05）.At T
5
and T
6
the HR and MAP were also significantly increased compared with those at T
0
in the control group
which were significantly higher than those in the trial group（P
<
0.05）.At all the measured time points
the R and SpO
2
were similar between the two groups（P
>
0.05）.At T
0
the blood glucose and cortisol levels were comparable between the two groups（P
>
0.05）.At T
a
T
b
T
5
and T
6
both the blood glucose and cortisol levels were significantly elevated compared with those at T
0
in the control group
which were significantly higher than those in the trial group（P
<
0.05）.The incidence of severe pain was significantly lower in the trial group than that in the control group（P
<
0.05）.The patient satisfaction score was significantly higher in the trial group than that in the control group（P
<
0.05）.Conclusion Scalp nerve block is superior to local infiltration for stereotactic evacuation of intracranial hematoma
which may reduce the intraoperative stress response
improve patient comfort during surgery
and enhance patient satisfaction.
关键词
头皮神经阻滞麻醉局部浸润麻醉立体定向颅内血肿清除术
Keywords
Scalp nerve block anesthesiaLocal infiltration anesthesiaStereotactic evacuation of intracranial hematoma
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