| 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（T0-L）、诱导后（T1）、切皮时刻（T2）、动脉剥离时刻（T3）、颈动脉阻断时刻（T4）、颈动脉开放时刻（T5）、术后2 h （T6）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（P>0.05）。单纯全麻组的收缩压在T2、T3时间点较T1时间点升高（P<0.01），其舒张压、平均动脉压和心率在T2时间点也均较T1时间点升高（P<0.01）。除术侧T4时间点，两组双侧脑氧饱和度在其他时刻均较T0-B时间点升高，但差异无统计学意义（P>0.05）。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（P<0.05，P<0.01），两组间MMSE评分的差异无统计学意义（P>0.05）。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。 |
| 关键词: 颈动脉内膜切除术 颈浅丛神经阻滞 全身麻醉 血流动力学 镇痛 |
| DOI：10.16781/j.0258-879x.2017.05.0628 |
| 投稿时间：2017-02-24修订日期：2017-04-18 |
| 基金项目:上海市科委科研基金（17XD1424300）. |
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| A comparative study of ultrasound-guided superficial cervical plexus block combined with general anesthesia and simple general anesthesia in carotid endarterectomy |
| SHI Hui-jing,ZOU Zui,LI Yong-hua,JIANG Xin,CHEN Wei,YUAN Hong-bin* |
(Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To explore the safety and efficacy of ultrasound-guided superficial cervical plexus block combined with general anesthesia in carotid endarterectomy (CEA). Methods Forty patients undergoing elective CEA were selected and divided into ultrasound-guided superficial cervical plexus block combined with general anesthesia group (combined with general anesthesia group) and simple general anesthesia group (general anesthesia group), with 20 cases in each group. We measured and analyzed the hemodynamics (invasive arterial blood pressure and heart rate), cerebral oxygen saturation, the doses of intra-operative anesthesia and vasoactive drug, post-operative visual analogue score (VAS), and one-day and three-day post-operative mini-mental state examination (MMSE) scores of the patients in the two groups at arrival to the operating room or before superficial cervical plexus block (T0-B), after superficial cervical plexus block (T0-L), after induction (T1), at skin incision moment (T2), at artery dissection moment (T3), at carotid artery occlusion moment (T4), at carotid artery opening moment (T5) and two hours after operation (T6). Results There was no significant difference in general situation between the two groups (P>0.05). In the general anesthesia group, the systolic blood pressures at T2 and T3 were significantly higher than that at T1 (P<0.01), and the diastolic blood pressure, mean arterial pressure and heart rate at T2 were significantly higher than those at T1 (P<0.01). Except at T4 of surgical side, the bilateral cerebral oxygen saturation at other time points in the two groups were higher than that at T0-B, but the difference was not statistically significant (P>0.05). Compared with the general anesthesia group, the anesthesia dosage, the times of vasoactive drug and the VAS were significantly decreased in the combined with general anesthesia group (P<0.05, P<0.01), and there was no significant difference in MMSE score between the two groups (P>0.05). Conclusion The ultrasound-guided superficial cervical plexus block combined with general anesthesia can contribute to a better hemodynamic and analgesic states in CEA, and can reduce the dosage of anesthesia and vasoactive drug. |
| Key words: carotid endarterectomy superficial cervical plexus block general anesthesia hemodynamics analgesia |
