头皮神经阻滞对颅内动脉瘤夹闭术开颅期血流动力学的影响

摘要

目的：评价罗哌卡因头皮神经阻滞对全麻下颅内动脉瘤夹闭术开颅期血流动力学的影响。方法：选择全麻下行颅内动脉瘤夹闭术患者76例，随机分为实验组（n=38）和对照组（n=38）。实验组在诱导后开颅前使用0.75%罗哌卡因实施头皮神经阻滞，对照组不实施头皮神经阻滞。观察术前（T1）、上头钉（T2）、切皮（T3）、钻颅骨（T4）时MAP和HR的变化，记录术中出现高血压及使用降压药物的例数。结果：两组患者T2~T4各时间点MAP显著低于T1（P<0.05）；实验组患者T2~T4各时间点MAP和HR与对照组比较，差异有统计学意义（P<0.05）。实验组术中出现高血压以及降压药物的使用率明显低于对照组，差异有统计学意义（P<0.05）。结论：头皮神经阻滞可以有效地减轻手术刺激造成的血流动力学反应，减少静脉镇痛药物以及降压药物的使用，为颅内动脉瘤夹闭术提供满意的麻醉效果。%　　Objective:To evaluate the effect of scalp nerve block with ropivacaine on hemodynamic responses during early stimulation in intracranial aneurysm surgery under general anesthesia. Method:Seventy six patients undergoing intracranial aneurysm surgery were randomly divided into experimental group(n=38)and control groups(n=38).Experimental group received scalp nerve block with 0.75%ropivacaine and control group do not received scalp nerve block.MAP and HR were recorded before operation(T0),head holder pinning(T1),skin incision(T2),drilling the skull(T4). The incidence of hypertension and the utilization of antihypertensive drug during operation were recored. Result:MAP at time points T2-T4 in two groups were significantly lower than T1(P<0.05).There is significant difference between the two groups for MAP and HR at time points T2-T4.The incidence of hypertension and the utilization of antihypertensive drug in experimental group was significantly lower than control group(P<0.05).Conclusion:Scalp nerve block with ropivacaine can successfully reduce the hemodynamic responses,decreasing antihypertensive drug usage,during early stimulation in intracranial aneurysm surgery under general anesthesia.