摘要
目的观察蝶腭神经节阻滞(SPGB)应用于颈动脉内膜剥脱术(CEA)的效果。方法选择2020年5月至2021年1月拟在全麻下行颈动脉内膜剥脱术的患者50例,男29例,女21例,年龄55~75岁,BMI 18~29 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:SPGB组(S组)和空白对照组(C组),每组25例。两组全麻方法一致,术毕S组接受经鼻纤维支气管镜引导下利多卡因复合罗哌卡因SPGB,C组不做任何处理。记录入室后即刻(T_(0))、麻醉诱导后15 min(T_(1))、夹闭后即刻(T_(2))、再通后即刻(T_(3))、术毕即刻(T_(4))、拔管前即刻(T_(5))、出室前即刻(T_(6))的MAP、HR、术侧及非术侧rSO_(2)。记录术后6、12、24、48 h头痛(VAS疼痛评分>3分)发生情况。记录患者术后住院时间。记录烦躁、失眠、局灶神经功能缺损等术后高灌注相关症状,脑出血及穿刺相关并发症发生情况。结果T_(0)—T_(6)时两组HR、MAP和非术侧rSO_(2)差异无统计学意义。T_(0)—T_(4)、T_(6)时两组术侧rSO_(2)差异无统计学意义。与C组比较,S组T_(5)时术侧rSO_(2)明显降低(P<0.05),术后6、12、24、48 h头痛发生率明显降低(P<0.05),术后失眠发生率明显降低(P<0.05),术后住院时间明显缩短(P<0.05)。两组烦躁、局灶神经功能缺损等术后高灌注相关症状差异无统计学意义。S组1例(4%)阻滞时出现血管损伤,C组术后2例(8%)发生术后脑出血。结论蝶腭神经节阻滞可以降低头痛发生率,改善患者术后睡眠,缩短住院时间,从而加速颈动脉内膜剥脱术患者的术后恢复。
Objective To observe the effect of sphenopalatine ganglion block(SPGB)on carotid endarterectomy.Methods Fifty patients undergoing carotid endarterectomy under general anesthesia from May 2020 to January 2021 were selected,29 males and 21 females,aged 55-75 years,BMI 18-29 kg/m^(2),ASA physical statusⅡorⅢ.The patients were randomly divided into two groups,SPGB group(group S)and control group(group C),25 patients in each group.Patients in sphenopalatine ganglion block group(group S)received lidocaine combined with ropivacaine block under the guidance of nasal fiberoptic bronchoscope.Patients in the control group did not have sphenopalatine ganglion block.All patients received the same methods of general anesthesia.The changes of MAP,HR,operative side and non-operative side rSO_(2) were continuously monitored and recorded on immediately after entering the operation room(T_(0)),15 minutes after anesthesia induction(T_(1)),immediately after clamping(T_(2)),immediately after recanalization(T_(3)),immediately after operation(T_(4)),immediately before extubation(T_(5)),and immediately before leaving the operating room(T_(6)).The postoperative hospital stay was recorded.The incidence of postoperative headache(VAS scores>3)6,12,24,and 48 hours after operation were recorded,and the incidence of postoperative hyperperfusion related symptoms such as dysphoria,insomnia and focal neurological deficits,cerebral hemorrhage and puncture-related complications were recorded.Results There were no significant differences in HR、MAP and non-operative side rSO_(2) at T_(0)-T_(6)between two groups,and there were no significant differences between operative side in rSO_(2) at T_(0)-T_(4)and T_(6).Compared with group C,the operative side rSO_(2) at T_(5)in group S significantly decreased(P<0.05).The incidence of postoperative headache significantly decreased 6,12,24,and 48 hours after operation(P<0.05).The incidence of postoperative insomnia significantly decreased(P<0.05),and the length of postoperative hospital stay was significantl
作者
彭天亮
宋永波
王志刚
李西荣
刘伟亮
孙绪德
PENG Tianliang;SONG Yongbo;WANG Zhigang;LI Xirong;LIU Weiliang;SUN Xude(Department of Anesthesia,Weifang Medical University,Weifang 261053,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2021年第9期933-936,共4页
Journal of Clinical Anesthesiology
关键词
蝶腭神经节阻滞
颈动脉内膜剥脱术
高灌注
头痛
Sphenopalatine ganglion block
Carotid endarterectomy
Hyperperfusion
Headache
