头部神经阻滞对全麻下神经外科上头架和开颅期间血流动力学及血糖的影响

目的:探讨头部神经阻滞对于全麻下神经外科上头架和开颅期间血流动力学及血糖的影响。方法:采用随机、双盲、对照设计,将40例大脑半球择期开颅手术患者分为头部神经阻滞组(B组)和空白对照组(P组),每组20例。静脉注射咪达唑仑0.05mg/kg、芬太尼3μg/kg、维库溴铵0.1mg/kg、丙泊酚2mg/kg诱导后行气管插管。吸入0.8最低肺泡有效浓度(MAC)异氟醚、静脉泵入5mg/(kg·h)丙泊酚维持麻醉。切皮前15min,完成双侧眶上神经、耳颞神经、枕大神经、枕小神经阻滞,B组采用0.5%罗哌卡因,P组采用生理盐水。记录手术前、上头架、切皮、锯颅骨时的平均动脉压(MAP)、心率(HR)和血糖(GLU)。结果:MAP、HR在上头架、切皮、开颅锯颅骨各个观察点,B组低于P组,差异有统计学意义(P<0.05);GLU在上头架、开颅锯颅骨时B组显著低于P组。结论:头部神经阻滞可以降低神经外科开颅前期外科操作引起的血流动力学波动,稳定糖代谢,有利于神经外科麻醉。

The effect of scalp nerve block on hemodynamics and blood glucose in head-pin insertion and early craniotomy under general anesthesia

Objective To observe the effect of scalp nerve block on hemodynamics and blood glucose in head-pin insertion and early craniotomy under general anesthesia.Methods In this double-blind,randomized,placebo-controlled study,40 patients with selective craniotomy received tracheal intubation following induction of anesthesia with intravenous midazolam of 0.05 mg/kg,fentanyl of 3 μg/kg,vecuronium of 0.1 mg/kg,and propofol of 2 mg/kg,and then received 0.5% ropivacaine of 2 mL for blocking the supraorbital nerve,aur...