摘要
目的探讨地佐辛联合头皮神经阻滞超前镇痛对开颅手术患者的镇痛效果及对其应激反应的影响。方法选取自2019年6月至2021年12月于中部战区总医院行开颅手术的108例患者为研究对象。采用随机数字表法将患者分为A组和B组,每组各54例。给予A组患者神经阻滞超前镇痛;B组在A组的基础上联合应用地佐辛。比较两组患者清醒拔管后即刻(T0)、术后6 h(T_(1))、术后12 h(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))的视觉疼痛模拟评分(VAS),神经阻滞前(T5)、神经阻滞即刻(T_(6))、麻醉后10 min(T_(7))、手术开始后10 min(T_(8))、手术结束时(T_(9))血流动力学指标[心率(HR)、平均动脉压(MAP)],T0、T_(3)、T_(4)时应激指标[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]及不良反应发生情况。结果B组和A组VAS评分均先升高后降低,且B组T_(1)、T_(2)、T_(3)、T_(4)时VAS评分均低于A组,差异有统计学意义(P<0.05)。B组T_(6)、T_(7)、T_(8)、T_(9)时HR、MAP低于A组,两组比较,差异有统计学意义(P<0.05)。两组T_(3)、T_(4)时E、NE、Cor均高于T0时,呈先升高后降低趋势,且B组T_(3)、T_(4)时E、NE、Cor低于A组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论开颅手术患者应用地佐辛联合头皮神经阻滞超前镇痛,镇痛效果确切,可有效减轻机体应激反应,安全性较好。
Objective To analyze the analgesic effect of dezocine and scalp nerve block preemptive analgesia in craniotomy and its effect on patients′stress response.Methods A total of 108 patients who underwent craniotomy in General Hospital of PLA Central Theater Command from June 2019 to December 2021 were selected as the study subjects.Patients were divided into group A and group B by random number table method,with 54 cases in each group.Patients in group A were given advanced nerve block analgesia.Patients in group B were treated with dezocine on the basis of group A.Visual analogue scale(VAS)were compared between the two groups immediately after conscious extubation(T0),6 hours(T_(1)),12 hours(T_(2)),24 hours(T_(3))and 48 hours(T_(4)).Hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]were compared between two groups before nerve block(T5),immediately after nerve block(T_(6)),10 minutes after anesthesia(T_(7)),10 minutes after operation(T_(8))and at the end of operation(T_(9)).Stress indexes[epinephrine(E),norepinephrine(NE)and cortisol(Cor)]at T0,T_(3)and T_(4)were compared between two groups.The incidence of adverse reactions was compared between the two groups.Results VAS scores of group B and Group A increased first and then decreased,and VAS scores of group B at each time point of T_(1),T_(2),T_(3),and T_(4)were lower than those of Group A,with statistical significance(P<0.05).HR and MAP at T_(6),T_(7),T_(8)and T_(9)in group B were lower than those in group A,and the differences were statistically significant(P<0.05).E,NE and Cor in T_(3)and T_(4)of the two groups were higher than those in T0,showing a trend of first increasing and then decreasing,and E,NE and Cor in T_(3)and T_(4)of group B were lower than those in group A,with statistical significance(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Dezocine combined with scalp nerve block for preemptive analgesia in patients undergoing craniotomy has definite analgesic effect,can effectively reduce the body′s stress response,and has good safety.
作者
陈晓龙
谈世刚
郭慧
甘国胜
宋晓阳
CHEN Xiao-long;TAN Shi-gang;GUO Hui;GAN Guo-sheng;SONG Xiao-yang(Department of Anesthesiology,General Hospital of PLA Central Theater Command,Wuhan 430000,China)
出处
《临床军医杂志》
CAS
2022年第4期368-371,共4页
Clinical Journal of Medical Officers
基金
湖北省卫生和计划生育委员会联合基金项目(WJ2018H0082)
作者简介
第一作者:陈晓龙(1989-),男,湖北黄冈人,主治医师;通信作者:甘国胜,E-mail:cxiaolongcxl@163.com
