头皮神经阻滞在立体定向颅内血肿清除术中对高血压脑出血患者应激状态及脑血流的影响

doi:10.3969/j.issn.1671-7171.2020.01.026

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摘要 【目的】 比较头皮神经阻滞(SNB)麻醉与局部浸润麻醉立体定向颅内血肿清除术对高血压脑出血患者应激状态及脑血流指标的影响。【方法】 回顾性分析2017 年6月至2018年12月本院收治的102例行立体定向颅内血肿清除术的高血压脑出血患者的临床资料,根据麻醉方式的不同将其分为阻滞麻醉组和浸润麻醉组,各51例。比较两组入室时(T₀)、切头皮时(T₁)、钻颅骨时(T₂)、缝皮时(T₃)血清空腹血糖(FPG)、皮质醇(Cor)水平及动脉血氧分压(PaO₂)、动脉血氧分压(PaCO₂)、动脉血氧饱和度(SaO₂)和平均动脉压(MAP)的变化。【结果】 阻滞麻醉组T₀、T₁、T₂、T₃时PaO₂、PaCO₂、SaO₂、MAP比较,差异均无统计学意义(P>0.05)。浸润麻醉组T₁、T₂、T₃时PaO₂低于T₀,PaCO₂、MAP高于T₀,差异有统计学意义(P<0.05)。浸润麻醉组T₁、T₂、T₃时PaO₂低于阻滞麻醉组,PaCO₂、MAP高于阻滞麻醉组,差异有统计学意义(P<0.05)。阻滞麻醉组T₀、T₁、T₂、T₃时血清FPG、Cor水平差异无统计学意义(P>0.05)。浸润麻醉组T₁、T₂、T₃时FPG、Cor水平均高于T₀,且均高于同时点阻滞麻醉组,差异有统计学意义(P<0.05)。【结论】 高血压脑出血患者行立体定向颅内血肿清除术采用头皮神经阻滞麻醉对脑血流影响小,应激反应轻,效果及安全性均优于局部浸润麻醉。

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	赵广平
	史炯
	程晶晶
	陈永学

关键词 ：脑出血/外科学, 高血压/病因学, 血肿/外科学, 神经传导阻滞

Abstract：【Objective】To compare the effect of stereotactic intracranial hematoma removal with SNB anesthesia and local infiltration anesthesia on stress state and cerebral blood flow index in patients with hypertensive intracerebral hemorrhage.【Methods】The clinical data of 102 patients with hypertensive intracerebral hemorrhage who underwent stereotactic evacuation of intracranial hematoma from June 2017 to December 2018 were analyzed retrospectively. According to the different anesthesia methods, they were divided into block anesthesia group and infiltration anesthesia group, 51 cases each; the changes of serum fasting blood glucose (FPG), cortisol (Cor) level and arterial partial pressure of oxygen (PaO₂), arterial partial pressure of oxygen (PaCO₂), arterial oxygen saturation (SaO₂) and mean arterial pressure (MAP) were compared between the two groups when entering the chamber (T₀), at scalp incision (T₁), at craniotomy (T₂) and at suture (T₃). 【Results】 There was no significant difference between PaO₂, PaCO₂, SaO₂ and MAP at T₀, T₁, T₂, T₃ in the block anesthesia group (P>0.05). In the invasive anesthesia group, PaO₂ was lower than T₀ at T₁, T₂, T₃, and PaCO₂, MAP was higher than T0, and the difference was statistically significant (P<0.05); the PaO₂ was lower in the invasive anesthesia group T₁, T₂, T₃ than in the block anesthesia group, and PaCO₂, MAP was higher than in the block anesthesia group, the difference was statistically significant (P<0.05). There was no significant difference in serum FPG and Cor levels in the block anesthesia group T₀, T₁, T₂, T₃(P>0.05). The average water of FPG and Cor in the invasive anesthesia group T₁, T₂, T₃ was higher than that of T₀, and all were higher than those in the simultaneous point block anesthesia group, the difference was statistically significant (P<0.05).【Conclusion】 Stereotactic evacuation of intracranial hematoma with scalp nerve block anesthesia for patients with hypertensive cerebral hemorrhageare has little effect on cerebral blood flow and light stress response with much more safety, and is better than local infiltration anesthesia.

Key words： Cerebral Hemorrhage/SU Hypertension/ET Hematoma/SU Nerve Block

收稿日期: 2019-03-19

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引用本文:

赵广平, 史炯, 程晶晶, 陈永学. 头皮神经阻滞在立体定向颅内血肿清除术中对高血压脑出血患者应激状态及脑血流的影响[J]. 医学临床研究, 2020, 37(1): 83-85.
ZHAO Guang-ping, SHI Jiong, CHENG Jing-jing,et al. Effect of Scalp Nerve Block on Stress Status and Cerebral Blood Flow in Patients with Hypertensive Intracerebral Hemorrhage during Stereotactic Intracranial Hematoma Removal. JOURNAL OF CLINICAL RESEARCH, 2020, 37(1): 83-85.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.01.026 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I1/83