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| 蝶腭神经节阻滞在颈动脉内膜剥脱术中的应用 |
| Application of sphenopalatine ganglion block in carotid endarterectomy |
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| DOI：10.12089/jca.2021.09.007 |
| 中文关键词: 蝶腭神经节阻滞 颈动脉内膜剥脱术 高灌注 头痛 |
| 英文关键词: Sphenopalatine ganglion block Carotid endarterectomy Hyperperfusion Headache |
| 基金项目: |
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| 中文摘要: |
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/m2,ASA Ⅱ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(T0)、麻醉诱导后15 min(T1)、夹闭后即刻(T2)、再通后即刻(T3)、术毕即刻(T4)、拔管前即刻(T5)、出室前即刻(T6)的MAP、HR、术侧及非术侧rSO2。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 T0—T6时两组HR、MAP和非术侧rSO2差异无统计学意义。T0—T4、T6时两组术侧rSO2差异无统计学意义。与C组比较,S组T5时术侧rSO2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。 |
| 英文摘要: |
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/m2, ASA physical status Ⅱ or Ⅲ. 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 rSO2 were continuously monitored and recorded on immediately after entering the operation room (T0), 15 minutes after anesthesia induction (T1), immediately after clamping (T2), immediately after recanalization (T3), immediately after operation (T4), immediately before extubation (T5), and immediately before leaving the operating room (T6). 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 rSO2 at T0-T6 between two groups, and there were no significant differences between operative side in rSO2 at T0-T4 and T6. Compared with group C, the operative side rSO2 at T5 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 significantly shorter (P < 0.05). There were no significant differences in postoperative hyperperfusion related symptoms such as irritability and focal neurological deficits between two groups. There was 1 patient (4%) in group S occurred vascular injury. There were 2 patients (8%) in group C occurred postoperative cerebral hemorrhage.
Conclusion Sphenopalatine ganglion block can reduce the incidence of headache, improve postoperative sleep, shorten hospital stay, thus it can accelerate the postoperative recovery of patients undergoing carotid endarterectomy. |
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