CAJ | 학술논문

目的：观察盐酸罗哌卡因不同时间点头部神经阻滞( SNB)用于开颅手术患者的术后镇痛效果。方法择期行开颅手术患者90例,采用随机数字表法分为3组：A组(手术开始前施行)、B组(手术结束后施行)、 C组(手术开始前与结束后两次阻滞),SNB均用0.5%盐酸罗哌卡因。术中所有患者采用相同麻醉方法,术后患者疼痛难忍时以双氯芬酸钠栓塞肛补救镇痛。记录手术部位、持续时间及切皮时呼气末七氟烷浓度；围手术期心率( HR)和收缩压( SBP)变化；术后0.5,2,4,6,12,24,48 h 视觉模拟评分(VAS)和Ramsay及格拉斯哥昏迷评分(GCS)；第一次补救镇痛时间和24 h消耗量；术后各种不良反应发生率、术中知晓、SNB 相关不良反应的例数及术后伤口愈合时间。结果与 B 组[(3.19±0.36)%]比较,A组[(1.81±0.24)%]和C组切皮所需呼气末七氟烷浓度[(1.77±0.33)%]明显较低(P<0.05)；B组术后2,4 h的疼痛评分分别为(2.77±1.98),(3.20±2.20)分,C组分别为(2.97±1.77),(2.27±1.93)分,A组分别为(3.77±2.27),(4.20±2.09)分,与B组和C组比较,A组明显增高(P<0.05),其他时间点差异无统计学意义(P>0.05)；A组术后24 h内补救镇痛药消耗量600 mg,B组300 mg,C组250 mg,B组和C组明显减少(P<0.05)；3组患者各观察时间点HR、SBP和GCS、Ramsay评分、第一次补救镇痛时间、恶心呕吐、眩晕发生率、伤口愈合时间均差异无统计学意义(均P>0.05)；所有患者无术中知晓、呼吸抑制、皮肤瘙痒或局麻药相关不良反应。结论术前盐酸罗哌卡因SNB可降低切皮所需呼气末七氟烷浓度,但术后镇痛效果有限；术后施行SNB可为神经外科开颅手术患者提供有效的过渡期镇痛；术前与术后两次SNB与仅行术后SNB相比,镇痛持续时间未见明显延长。
목적：관찰염산라고잡인불동시간점두부신경조체( SNB)용우개로수술환자적술후진통효과。방법택기행개로수술환자90례,채용수궤수자표법분위3조：A조(수술개시전시행)、B조(수술결속후시행)、 C조(수술개시전여결속후량차조체),SNB균용0.5%염산라고잡인。술중소유환자채용상동마취방법,술후환자동통난인시이쌍록분산납전새항보구진통。기록수술부위、지속시간급절피시호기말칠불완농도；위수술기심솔( HR)화수축압( SBP)변화；술후0.5,2,4,6,12,24,48 h 시각모의평분(VAS)화Ramsay급격랍사가혼미평분(GCS)；제일차보구진통시간화24 h소모량；술후각충불량반응발생솔、술중지효、SNB 상관불량반응적례수급술후상구유합시간。결과여 B 조[(3.19±0.36)%]비교,A조[(1.81±0.24)%]화C조절피소수호기말칠불완농도[(1.77±0.33)%]명현교저(P<0.05)；B조술후2,4 h적동통평분분별위(2.77±1.98),(3.20±2.20)분,C조분별위(2.97±1.77),(2.27±1.93)분,A조분별위(3.77±2.27),(4.20±2.09)분,여B조화C조비교,A조명현증고(P<0.05),기타시간점차이무통계학의의(P>0.05)；A조술후24 h내보구진통약소모량600 mg,B조300 mg,C조250 mg,B조화C조명현감소(P<0.05)；3조환자각관찰시간점HR、SBP화GCS、Ramsay평분、제일차보구진통시간、악심구토、현훈발생솔、상구유합시간균차이무통계학의의(균P>0.05)；소유환자무술중지효、호흡억제、피부소양혹국마약상관불량반응。결론술전염산라고잡인SNB가강저절피소수호기말칠불완농도,단술후진통효과유한；술후시행SNB가위신경외과개로수술환자제공유효적과도기진통；술전여술후량차SNB여부행술후SNB상비,진통지속시간미견명현연장。
Objective To observe the effect of scalp nerve block ( SNB ) with ropivacaine hydrochloride at different time points on pain management after craniotomy. Methods Ninety patients undergoing craniotomy were randomly divided into 3 groups:group A, SNB conducted before surgery;group B, SNB conducted after surgery;group C, SNB conducted both before and after surgery, with 0. 5% of ropivacaine hydrochloride in each group. All patients received the same general anesthesia and diclofenac sodium were administered rectally as rescue analgesics. Sites and duration of surgeries, end-tidal sevoflurane concentration during incision, HR and SBP levels during the course of surgery and postoperative period, the VAS scores, GCS and Ramsay scores at 0. 5, 2, 4, 6, 12, 24, 48 h postoperatively, time of the first rescue appication analgesics and total consumption of rescue analgesics, the adverse effects, awareness under anesthesia were analyzed respectively, as well as local anesthesia relevant adverse events and time of wound healing. Results The end-tidal sevoflurane concentration was significantly decreased in group B (3. 19±0. 36)% as compared with group A (1. 81±0. 24)% and C (1. 77±0. 33)% (P<0. 05);The VAS scores of group A (3. 77±2. 27, 4. 20±2. 09) at 2 and 4 h were higher than those in group B (2. 77±1. 98, 3. 20±2. 20) and C (2. 97±1. 77,2. 27±1. 93) (P<0. 05), while at other time points the differences were not significant (P>0. 05);Compared with group A (600 mg), the consumption of rescue analgesics of group B (300 mg) and C (250 mg) were statistically lower (P<0. 05);Vital signs, GCS, Ramsay scores, time of the first rescue analgesics postoperatively used, and time of wound healing among the three groups were not various significantly (P>0. 05);The relevant side effects were not different statistically, and there were no patients suffering from obvious awareness under anesthesia, pruritus, respiratory depression or local anesthesia relevant adverse effects. Conclusion SNB conducted before surgery can decrease the consumption of sevoflurane during incision, but has limited analgesic effects postoperatively. SNB conducted after surgery may provide transitional analgesia for neurosurgical patients undergoing craniotomy, while SNB conducted both before and after surgery does not show significantly longer analgesic time in postoperative pain management.