颈动脉内膜剥脱术中不同麻醉技术的联合应用

目的 探讨颈动脉内膜斑块剥脱术（CEA）中不同麻醉技术的效果和安全性。方法 选择312例需行CEA患者，依据麻醉方法分为4组:Ⅰ组，46例，常规全麻；Ⅱ组，53例，在Ⅰ组基础上，气管插管前用2%利多卡因5 ml行喉及气管内表麻2 min后插管；Ⅲ组，101例，在Ⅱ组基础上，在手术开始前用0.25%罗哌卡因行患侧颈丛神经阻滞；Ⅳ组，112例，在Ⅲ组基础上，术中暴露颈动脉后用1%利多卡因1 ml行颈动脉窦浸润麻醉。分析4组进入手术室（T0）、诱导气管插管成功后1 min（T1）、颈动脉阻断即刻（T2）、颈动脉松开即刻（T3）、术毕拔管（T4）和术毕1 h（T5）心率（HR）和平均动脉压（MAP）变化以及术中不良事件、术后并发症、麻醉药物用量差异。结果 与Ⅱ~Ⅳ组相比，Ⅰ组T1和T4时刻HR和MAP明显升高（P<0.05），术中血压增高、心动过速发生率明显增高（P<0.05）。Ⅰ、Ⅱ组异丙酚和瑞芬太尼用量、病人清醒视觉模拟疼痛量表评分明显高于Ⅲ、Ⅳ型（P<0.05）。Ⅳ组术中心动过缓和低血压发生率明显低于其余3组（P<0.05）。结论 CEA患者采用全麻联合气管内表面麻醉、颈丛神经阻滞或颈动脉窦阻滞可以稳定该类病人术中的血流动力学，减少全麻药的用量，提供良好的术后镇痛效果。

Application of different techniques of anesthesia to carotid endarterectomy in patients with symptomatic carotid stenoses

Objective To explore the safety of different local anesthesias including the airway surface anesthesia, cervical plexus block anesthesia and infiltration anesthesia of carotid sinus after the systemic anesthesia during carotid endarterectomy (CEA) and their effects in the patients with symptomatic carotid stenoses. Method Three hundred and twelve patients with symptomatic carotid stenoses, who underwent CEA, were divided into 4 groups, i.e. group Ⅰ (n=46) in which the routine systemic anesthesia (RSA) was performed, group Ⅱ (n=53) in which RSA and the airway surface anesthesia before the tracheal intubation were performed, group Ⅲ (n=101) in which RSA, the airway surface anesthesia before the tracheal intubation and the cervical plexus block anesthesia were performed and group Ⅳ (n=112) in which the infiltration anesthesia of the carotid sinus was performed on the basis of the anesthesias in group Ⅲ. The safety of the anesthesias and their effects were compared among all the groups. Results The heart rate (HR) was significantly faster and the mean arterial pressure (MAP) was significantly higher in group Ⅰ than those in the other three groups immediately after the successful intubation and immediately after the extraction of the tube from the airway (P<0.05). The rates of occurrences of tachycardia, bradycardia, hypertension and hypotension were significantly lower in group Ⅳ than those in the other three groups (P<0.05). The scores of visual analogue scale were significantly higher and the dosage of propofol and remifentanil was significantly bigger in groups Ⅰ and Ⅱ than those in groups Ⅲ and Ⅳ (P<0.05). Conclusions The rate of occurrence of poor cardiovascular event and dosage of anesthetics used for CEA may be reduced, and the good analgesia effect after CEA may be reached by the systemic anesthesia combined with the local anesthesias including the airway surface anesthesia, cervical plexus block anesthesia and infiltration anesthesia of the carotid sinus in the patients with symptomatic carotid stenoses.