浏览全部资源
扫码关注微信
超声引导与体表定位头皮神经阻滞用于术中唤醒开颅手术的效果比较
Efficacy of ultrasound-guided versus body surface localization on scalp nerve block in awake craniotomy: report of 82 cases
- 陆军军医大学学报 2023年45卷第6期 页码：547-553
- 作者机构：
1.400010 重庆, 重庆医科大学附属第一医院麻醉科
2.400010 重庆, 重庆医科大学附属第二医院麻醉科
3.400037 重庆, 陆军军医大学(第三军医大学)第二附属医院麻醉科
- 作者简介：
[陈玉培，E-mail：963043115@qq.com CHEN Yupei, E-mail: 963043115@qq.com
- 基金信息：国家自然科学基金面上项目(81172122)
DOI：10.16016/j.2097-0927.202209191
中图分类号： R181.32;R614.4;R651.11收稿：2022-09-21，
修回：2022-10-12，
纸质出版：2023-03-30
- 稿件说明：
移动端阅览
万孟宁, 陈玉培, 邓友良, 等. 超声引导与体表定位头皮神经阻滞用于术中唤醒开颅手术的效果比较[J]. 陆军军医大学学报, 2023,45(6):547-553.
Mengning WAN, Yupei CHEN, Youliang DENG, et al. Efficacy of ultrasound-guided versus body surface localization on scalp nerve block in awake craniotomy: report of 82 cases[J]. Journal of Army Medical University, 2023, 45(6): 547-553.
万孟宁, 陈玉培, 邓友良, 等. 超声引导与体表定位头皮神经阻滞用于术中唤醒开颅手术的效果比较[J]. 陆军军医大学学报, 2023,45(6):547-553. DOI： 10.16016/j.2097-0927.202209191.
Mengning WAN, Yupei CHEN, Youliang DENG, et al. Efficacy of ultrasound-guided versus body surface localization on scalp nerve block in awake craniotomy: report of 82 cases[J]. Journal of Army Medical University, 2023, 45(6): 547-553. DOI： 10.16016/j.2097-0927.202209191.
摘要
目的
2
对比术中唤醒开颅手术(awake craniotomy
AC)中应用超声引导下头皮神经阻滞(ultrasound-guided scalp nerve block
US-guided SNB)与体表定位头皮神经阻滞(scalp nerve block
SNB)的效果差异。
方法
2
采用回顾性队列研究，分析2016年1月至2022年1月就诊于重庆医科大学附属第一医院及陆军军医大学第二附属医院神经外科的82例脑功能区病变患者的病历资料。其中接受US-guided SNB的纳入观察组(
n
=39)，患者年龄(50.51±16.49)岁，男19例，体质指数(22.10±3.66)kg/m
2
。接受体表定位SNB的纳入对照组(
n
=43)，患者年龄(48.02±16.44)岁，男24例，体质指数(22.98±3.55) kg/m
2
。比较两组患者的一般资料、手术相关指标及术后并发症情况。记录入室时(T0)、切皮完成时(T1)、唤醒时(T2)、唤醒后10 min(T3)、唤醒后20 min(T4)的平均动脉压(mean arterial pressure
MAP)和心率(heart rate
HR)。
结果
2
观察组的术中唤醒时间(6.53±1.84) min、唤醒期体动次数(4.92±2.61) 次/h、盐酸尼卡地平(0.97±0.27) mg、瑞芬太尼(1.08±0.35) mg、盐酸右美拖咪定(1.30±0.33) mg以及枸橼酸舒芬太尼(22.42±2.63) ug的用量显著低于对照组，差异均有统计学意义(均
P
<
0.05)。两组的HR在T1-T4均呈逐渐上升趋势，其中对照组HR上升更明显，组间比较差异有统计学意义(
F
=35.978
P
<
0.001)。观察组MAP在T1-T2逐渐上升，在T3-T4呈下降趋势，对照组T1-T3呈上升趋势，T4期有所回降，且明显高于观察组，组间比较差异有统计学意义(
F
=43.286
P
<
0.001)。
结论
2
US-guided SNB技术具有提升AC手术唤醒期手术质量、减少术中全身麻醉药用量、稳定血流动力学的作用。
Abstract
Objective
2
To compare the efficacy of ultrasound-guided scalp nerve block (US-guided SNB) with that of body surface localization SNB in awake craniotomy (AC).
Methods
2
A retrospective cohort study was conducted to analyze the medical records of 82 patients with brain lesions who were treated in the Department of Neurosurgery
the First Affiliated Hospital of Chongqing Medical University and the Second Affiliated Hospital of Army Medical University from January 2016 to January 2022. The patients receiving US-guided SNB were included in the observation group (
n
=39
19 males
averagely aged 50.51±16.49 years
body mass index of 22.10±3.66 kg/m
2
)
and those receiving body surface localization SNB were enrolled in the control group (
n
=43
24 males
averagely aged 48.02±16.44 years
body mass index of 22.98±3.55 kg/m
2
). The general information
operation-related indicators
and postoperative complications were compared between the 2 groups. Mean arterial pressure (MAP) and heart rate (HR) were recorded and analyzed at the time of admission (T0)
skin incision (T1)
awakening (T2)
and 10 min (T3) and 20 min (T4) after awakening.
Results
2
In the observation group
the intraoperative wake-up time (6.53±1.84 min)
number of body movements during the awake period (4.92±2.61 times/h)
as well as dosages of nicardipine hydrochloride (0.97±0.27 mg)
remifentanil (1.08±0.35 mg)
dexmedetomidine hydrochloride (1.30±0.33 mg)
and sufentanil citrate (22.42±2.63 ug) were significantly lower than those in the control group
with statistical significances (all
P
<
0.05). The HR of both groups showed a gradual upward trend at T1~T4
and the increase in the control group was much obvious with significance (
F
=35.978
P
<
0.001). The MAP of the observation group was elevated at T1~T2 and then declined at T3~T4
while the MAP in the control group was increased during T1~T3 and decreased at T4
greatly higher than that in the observation group (
F
=43.286
P
<
0.001).
Conclusion
2
US-guided SNB technique can improve the quality of AC surgery during awake period
reduce the intraoperative dose of general anesthetics
and stabilize hemodynamics.
关键词
Keywords
references
KULIKOV A, LUBNIN A. Anesthesia for awake craniotomy[J]. Curr Opin Anaesthesiol, 2018, 31(5): 506-510. DOI: 10.1097/ACO.0000000000000625.
FONTAINE D, ALMAIRAC F. Pain during awake craniotomy for brain tumor resection. Incidence, causes, consequences and management[J]. Neurochirurgie, 2017, 63(3): 204-207. DOI: 10.1016/j.neuchi.2016.08.005.
POTTERS J W, KLIMEK M. Local anesthetics for brain tumor resection: current perspectives[J]. Local Reg Anesth, 2018, 11: 1-8. DOI: 10.2147/lra.s135413.
NANAYAKKARA D, MANAWARATNE R, SAMPATH H, et al . Supraorbital nerve exits: positional variations and localization relative to surgical landmarks[J ] . Anat Cell Biol, 2018, 51(1): 19-24. DOI: 10.5115/acb.2018.51.1.19.
CHOWDHURY T, BARON K, CAPPELLANI R B. Severe bradycardia during scalp nerve block in patient undergoing awake craniotomy[J]. Saudi J Anaesth, 2013, 7(3): 356-357. DOI: 10.4103/1658-354x.115344.
CHIN K J, CHAN V. Ultrasound-guided peripheral nerve blockade[J]. Curr Opin Anaesthesiol, 2008, 21(5): 624-631. DOI: 10.1097/aco.0b013e32830815d1.
RE M, BLANCO J, GÓMEZ DE SEGURA I A. Ultrasound-guided nerve block anesthesia[J]. Vet Clin North Am Food Anim Pract, 2016, 32(1): 133-147. DOI: 10.1016/j.cvfa.2015.09.003.
ZETLAOUI P J, GAUTHIER E, BENHAMOU D. Ultrasound-guided scalp nerve blocks for neurosurgery: a narrative review[J]. Anaesth Crit Care Pain Med, 2020, 39(6): 876-882. DOI: 10.1016/j.accpm.2020.06.019.
程芳, 林华赋, 萧燕萍, 等. 超声引导头部神经阻滞在幕上肿瘤切除术中的应用[J]. 医学综述, 2020, 26(10): 2026-2030. DOI: 10.3969/j.issn.1006-2084.2020.10.029.
CHENG F, LIN H F, XIAO Y P, et al . Application of ultrasound-guided head nerve block in supratentorial tumor resection[J ] . Med Recapitul, 2020, 26(10): 2026-2030. DOI: 10.3969/j.issn.1006-2084.2020.10.029.
HORVATH B, KLOESEL B, TODD M M, et al . The evolution, current value, and future of the American society of anesthesiologists physical status classification system[J ] . Anesthesiology, 2021, 135(5): 904-919. DOI: 10.1097/ALN.0000000000003947.
SOLERA RUIZ I, UÑA OREJÓN R, VALERO I, et al . Awake craniotomy. Considerations in special situations[J ] . Rev Esp Anestesiol Reanim, 2013, 60(7): 392-398. DOI: 10.1016/j.redar.2013.01.001.
CHAKI T, SUGINO S, JANICKI P K, et al . Efficacy and safety of a lidocaine and ropivacaine mixture for scalp nerve block and local infiltration anesthesia in patients undergoing awake craniotomy[J ] . J Neurosurg Anesthesiol, 2016, 28(1): 1-5. DOI: 10.1097/ANA.0000000000000149.
SAHU A, KOHT A H. Unusual manifestations of the trigeminocardiac reflex during awake craniotomy: a case report and review of the literature[J]. A A Pract, 2021, 15(8): e01508. DOI: 10.1213/xaa.0000000000001508.
刘鸽, 赖峻松, 李敏, 等. 幕上肿瘤切除术中超声引导头部神经阻滞对患者认知功能和睡眠质量的影响分析[J]. 中国医学创新, 2021, 18(23): 14-18.
LIU G, LAI J S, LI M, et al . Effect of ultrasound-guided cranial nerve block on cognitive function and sleep quality in supratentorial tumor resection[J ] . Med Innov China, 2021, 18(23): 14-18.
LIU J, YUAN K, ZHOU H, et al . A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery[J ] . BMC Anesthesiol, 2020, 20(1): 234. DOI: 10.1186/s12871-020-01155-y.
0
浏览量
0
下载量
0
CSCD
- 网络PDF下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
