左旋布比卡因头皮神经阻滞在开颅手术中的应用

目的 对比研究开颅手术中使用左旋布比卡因头皮神经阻滞复合全身麻醉对循环指标的影响及手术相关麻醉费用情况。方法 2011年3月至2013年8月神经外科需要开颅手术患者60例随机分为两组：对照（D）组（n=30）和左旋布比卡因（L）组（n=30）。麻醉诱导插管后L组采用0.25%左旋布比卡因行患侧相关头皮神经阻滞,D组不实行神经阻滞但常规按时给予舒芬太尼和肌松药,两组手术中均采用丙泊酚持续输注维持麻醉。记录术中镇痛、镇静药用药量、循环相关指标、拔管后疼痛视觉模拟评分（VAS）值及手术相关麻醉费用。结果 D组与L组比较,手术期舒芬太尼用量[（1.67±0.24）、（0.20±0.11）μg/kg],丙泊酚用量[（5.27±2.15）、（3.62±1.36）mg·kg-1·h-1],拔管后VAS评分[（7.21±1.40）、（3.15±1.20）分],手术相关麻醉费用[（1 683±64）、（1 327±71）元],前者均高于后者（P均〈0.05）;手术开始至苏醒拔管,D组平均动脉压、心率上升较L组明显（P均〈0.05）。结论左旋布比卡因头皮神经阻滞操作简单,安全性高,术中血流动力学稳定,复合全身麻醉能增加麻醉的可控性,术毕苏醒拔管平稳,可降低苏醒期的风险,减少住院时间和手术相关的麻醉费用,是神经外科手术麻醉的一种新的辅助技术。

Application of scalp nerve block with levobupivacaine in the craniotomy surgery

Objective To compare the influences of scalp nerve block with levobupivacaine combined with general anesthesia in craniotomy on circulation-relative indicator and anesthesia costs condition related to the operation. Methods Sixty patients needed performing craniotomy between March 2011 and August 2013 were randomly divided into two groups （ n = 30 each ） ： control group （ D group ） and levobupivacaine group （ L group ）. After anesthesia induction intubation, the scalp nerve block with 0.25% levobupivacaine in relative sick side was performed in L group; the scalp nerve block was not performed, but snfentanil and muscle relaxant were routinely given on time in D group. Propofol was continuously infused in operation for maintaining anesthesia in both two groups. The dosages of analgesics and sedative drugs and circulation-relative indicators in operation, the pain visual analogue scale （VAS） after extubation, and anesthesia costs related to the operation were recorded. Results Compared with L group,all the observed items of D groups increased significantly：the dosage of snfentanil[ （1.67 ±0. 24） μg/kg vs （0.20 ±0.11 ）μg/kg ], the dosage of propofol [ （ 5.27 ± 2.15 ） mg · kg - 1 . h - 1 vs （ 3.62± 1.36 ）mg. kg-1 · h-1] ,the VAS scores after extubation[ （7.21 ±1.40） vs（3.15 ±1.20）] and the anesthesia costs related to the operation[ 1 683 ±64）yuan vs （1 327± 71 ）yuan ], and there were significantly differents between two groups（ all P 〈 0.05 ）. From beginning operation to waking and extubation, mean arterial pressure and heart rate in D group increased significantly compared with L group （ all P 〈 0.05 ）. Conclusions The scalp nerve block with levobupivacaine is a kind of new assistive technique of anesthesia in neurosurgery operation which can be simple to operate,have higher safety and stable hemodynamics in operation, increase controllability of anesthesia when it combined with general anesthesia, draw tube smoothly and steadily at the time o