头皮神经阻滞对颅内动脉瘤术后 患者血浆皮质醇的影响

Effect of scalp nerve block on postoperative plasma level of cortisol in patients with intracranial aneurysm

摘要:

目的 通过术前头皮神经阻滞对颅内动脉瘤夹闭术后患者血浆皮质醇的改变，评估颅脑外科手 术行头皮神经阻滞镇痛，减轻术后应激反应的效果。方法 选取2016 年10 月-2017 年5 月在该院神经外科 成功实施颅内动脉瘤夹闭手术的患者46 例。随机分为神经阻滞组和非神经阻滞组，每组23 例。神经阻滞组 患者用0.5% 罗派卡因分别阻滞头部两侧对称的枕大神经、枕小神经、眶上神经和耳颞神经，非神经阻滞组患 者只实施全身麻醉。在快速诱导全身麻醉前，以及术后2、6、12 和24 h 时分别抽取外周静脉血测定血浆皮 质醇水平，同期记录疼痛视觉模拟评分（VAS）和不良反应。结果 神经阻滞组术后2、6 和12 h 的VAS 评 分较非神经阻滞组低（P <0.05）。两组血浆皮质醇水平术后2 ～ 24 h 较快速诱导气管插管前升高（P <0.05）。 与非神经阻滞组比较，神经阻滞组术后2 ～ 12 h 血浆皮质醇水平降低（P <0.05）。结论 0.5% 罗派卡因头皮 神经阻滞是开颅术后镇痛的有效方法，可在一定程度上抑制应激反应。

Abstract:

Objective To investigate the effect of postoperative pain on plasma cortisol and preoperative scalp nerve block on reducing postoperative stress after clipping of intracranial aneurysm. Methods Forty-six ASA I-Ⅲ patients aged 19-65 yr undergoing clipping of cerebral aneurysms were recruited and randomly divided into a preoperative scalp nerve block group (group N) and a control group (group M) with 23 in each group. The patients in the group N received scalp nerve block with 0.5% Ropivacaine after induction while those in the group M did not. The concentration of plasma cortisol was measured before induction and 2, 6, 12 and 24 h after surgery, and Visual Analgesia Scale (VAS) and side effects were evaluated at the same time. Results Postoperative VAS scores were significantly lower in the group N than in the group M at 2, 6 and 12 h after surgery (P < 0.05). The plasma level of corticosteroid was noticeably increased after surgery compared to that before general anesthesia induction intubation in both groups (P < 0.05). But the plasma level of cortisol was noticeably lower in the group N than in the group M at 2-12 h after surgery (P < 0.05). Conclusions Preoperative scalp nerve block with 0.5% Ropivacaine provides effective postoperative analgesia and may depress stress action after craniotomy.