摘要
目的观察罗哌卡因神经阻滞复合体温调节对全身麻醉高龄患者三叉神经痛手术后苏醒质量的影响。方法选择三叉神经微血管减压术的高龄患者(≥70岁)56例,随机双盲分为常规全身麻醉组(A组,28例)和改良全身麻醉组(B组,28例)。B组患者麻醉改良措施包含:(1)开始缝硬脑膜时调节体温至37℃左右;(2)头皮缝合完毕时,实施手术侧相关神经阻滞。监测围术期患者循环、呼吸、体温的变化。记录手术时间、麻醉维持用药量、自主呼吸恢复时间、睁眼时间、拔除气管导管时间、拔除气管导管时Ramsay镇静评分和拔除气管导管后30 min视觉模拟评分(visual analogue scale,VAS)。统计患者手术室期间的出入量。结果 56例患者顺利完成资料收集。与B组比较,A组患者心率在下头钉时(T1)显著降低(P <0.001),而在拔除气管导管前(T2)、拔除气管导管后5 min(T3)均明显升高(均P <0.001);A组患者平均动脉压在T2、T3时均明显升高(均P <0.001);A组患者体温在T1、T2时均显著降低(均P <0.001)。与A组比较,B组患者自主呼吸恢复时间、睁眼时间、拔除气管导管时间均显著缩短,拔除气管导管后30 min VAS评分显著降低(均P <0.001),尿量显著增多(P <0.05)。结论罗哌卡因神经阻滞复合体温调节有利于全身麻醉高龄三叉神经微血管减压术患者获得理想的苏醒质量。
Objective The aim of this study is to evaluate the effect of ropivacaine nerve block combined with thermoregulation on the recovery quality among elderly patients who underwenttrigeminal nerve microvascular decompression under general anesthesia.Methods A total of 56 elderly patients(≥70 years old)with trigeminal nerve microvascular decompressionwere randomized into conventional general anesthesia group(group A,n=28)and improved general anesthesia group(group B,n=28).The improved anesthesia management programs were used in the patients assigned to group B.Firstly,immediately at the start of the sewing of the dura,body temperature was regulated to approximately 37℃.Secondly,after scalp suture was completed,nerve blocks were performed on the operated side.Circulation,respiration,and body temperature in the perioperative period were monitored.The duration of surgery,amount of drugs used to maintain anesthesia,time used for spontaneous breathing recovery,time used for eye opening,timeused for tracheal catheter removal,Ramsay sedation score during tracheal catheter removal,and Visual Analogue Scale(VAS)at 30 minutes after tracheal catheter removal,were recorded respectively.The amounts of fluid input and fluid loss in the operating room were determined.Results 56 cases were collected successfully.Compared with heart rates of group B,heart rates in group A significantly decreased after the removal of the head retainer(T1;P<0.001),while significantly increased before the removal of the endotracheal tube(T2;P<0.001)and 5 minutes after the removal of tracheal catheter(T3;P<0.001).Average arterial pressure in group A significantly increased at T2 and T3(P<0.001),and the body temperatures of the patients in group A decreased significantly at T1 and T2(P<0.001).Timeused for spontaneous breathing recovery,eye opening,and tracheal catheter removal significantly decreased in group B compared with those in group A.VAS score at 30 minutes after tracheal catheter removalin group B significantly decreased(P≤0.001),and urine volume in group B significantly increased(P<0.05).Conclusions Ropivacaine nerve block combined with thermoregulation is beneficial to achieving better recovery quality among elderly patients who underwent trigeminal nerve microvascular decompression under general anesthesia.
作者
余奇劲
肖兴鹏
杨云朝
YU Qijing;XIAO Xingpeng;YANG Yunzhao(Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第23期3656-3660,共5页
The Journal of Practical Medicine
基金
湖北省卫生计生委科研资助项目（编号：WJ2015MB023）
关键词
神经阻滞
罗哌卡因
体温
老年
三叉神经微血管减压术
苏醒
nerve block
ropivacaine
body temperature
elderly patients
trigeminal nerve micro-vascular decompression
recovery
