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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
王涛,陈秀侠,黄晶晶,孟香弟,李霞.超声引导颈浅丛神经阻滞联合全身麻醉对颈动脉内膜剥脱术患者术后恢复质量及认知功能的影响[J].中华老年多器官疾病杂志,2020,19(9):680~685
超声引导颈浅丛神经阻滞联合全身麻醉对颈动脉内膜剥脱术患者术后恢复质量及认知功能的影响
Effect of ultrasound-guided superficial cervical plexus block combined with general anesthesia on postoperative recovery quality and cognitive function in patients undergoing carotid endarterectomy
投稿时间:2019-11-16  
DOI:10.11915/j.issn.1671-5403.2020.09.158
中文关键词:  颈动脉内膜切除术;颈浅丛神经阻滞;全身麻醉;恢复质量;认知功能
英文关键词:carotid endarterectomy; superficial cervical plexus block; general anesthesia; quality of recovery; cognitive function Corresponding author:CHEN Xiu-Xia, E-mail:cxxlxy@sina.com〖FL
基金项目:
作者单位E-mail
王涛 徐州医科大学 麻醉学系,江苏 徐州 221004 cxxlxy@sina.comeffect 
陈秀侠 徐州医科大学 附属医院麻醉科,江苏 徐州 221004 cxxlxy@sina.comeffect 
黄晶晶 徐州医科大学 麻醉学系,江苏 徐州 221004 cxxlxy@sina.comeffect 
孟香弟 徐州医科大学 麻醉学系,江苏 徐州 221004 cxxlxy@sina.comeffect 
李霞 徐州医科大学 急救与救援医学系,江苏 徐州 221004 cxxlxy@sina.comeffect 
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中文摘要:
      目的 比较超声引导下颈浅丛神经阻滞联合全身麻醉与单纯全身麻醉对颈动脉内膜剥脱术(CEA)患者术后早期恢复质量及认知功能的影响。方法 选取2018年11月至2019年8月在徐州医科大学附属医院择期行CEA的患者60例。采用随机数表法分为2组:超声引导颈浅丛神经阻滞联合全身麻醉组(研究组)和全身麻醉组(对照组),每组30例。研究组于全身麻醉前行超声引导下颈浅丛神经阻滞。记录2组不同时间点的恢复质量(QoR-15)评分、简易精神状态检查(MMSE)评分、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)。对比2组患者不良事件发生率、血管活性药物使用以及麻醉药物的用量。采用SPSS 19.0软件进行统计分析。2组间比较采用t检验或χ2检验。结果 研究组患者术后1d时的QoR-15总分显著高于对照组[(102.67±10.16)和(91.87±10.13),P<0.05]。2组患者MMSE评分在各时间点组间比较均无统计学差异(P>0.05)。研究组患者切皮时的SBP[(125.56±9.55)和(135.86±13.68)mmHg]、DBP[(66.92±9.32)和(76.77±11.73)mmHg]、MAP[(86.47±9.02)和(96.47±11.50)mmHg]、HR[(65.77±6.64)和(70.50±4.93)次/min]均显著低于对照组(P<0.05)。研究组患者高血压(40.0%和70.0%)、恶心呕吐(13.3%和36.7%)、低氧血症发生率(3.3%和23.3%)及降压药物使用率(40.0%和66.7%)均显著低于对照组(P<0.05)。研究组舒芬太尼[(0.14±0.03)和(0.23±0.03)μg/kg]、瑞芬太尼[(13.56±2.35)和(22.13±2.31)μg/kg]、丙泊酚[(7.64±1.04)和(9.01±1.18)mg/kg]用量显著少于对照组(P<0.05)。结论 在CEA中,超声引导下颈浅丛神经阻滞联合全身麻醉较单纯全身麻醉能提高术后短期QoR-15评分、稳定围术期血流动力学、减少麻醉药和血管活性药的用量,术后不良事件较少。
英文摘要:
      Objective To compare the effect of ultrasound-guided superficial cervical plexus (SCP) block combined with general anesthesia versus general anesthesia alone on early recovery quality and cognitive function in patients undergoing carotid endarterectomy (CEA). Methods A total of 60 patients undergoing elective CEA in our affiliated hospital from November 2018 to August 2019 were enrolled, and randomly divided into the observation group (ultrasound-guided SCP block combined with general anesthesia) and control group (general anesthesia), with 30 cases in each group. The quality of recovery score (QoR-15), score of mini-mental state examination (MMSE), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were recorded at different time points in both groups. The incidence of adverse events, use of vasoactive drugs and dose of anesthetics were compared between the two groups. SPSS statistics 19.0 was used for data analysis. Student′s t test or Chi-square test was employed for comparison between the two groups. Results The total score of QoR-15 at 1d after surgery was significantly higher in the observation group than the control group [(102.67±10.16) vs (91.87±10.13), P<0.05]. But there were no statistical differences in MMSE scores at different time points between the 2 groups (P>0.05). The observation group had obviously lower SBP[(125.56±9.55) vs (135.86±13.68)mmHg], DBP [(66.92±9.32) vs (76.77±11.73)mmHg], MAP [(86.47±9.02) vs (96.47±11.50)mmHg], and HR [(65.77±6.64) vs (70.50±4.93)beats/min] at moment of incision than the control group (P<0.05). There were notably less patients having hypertension (40.0% vs 70.0%), experiencing nausea and vomiting (13.3% vs 36.7%) and hypoxemia (3.3% vs 23.3%), and using antihypertensive drug (40.0% vs 66.7%) in the observation group than the control group (P<0.05). Less dosages of sufentanil [(0.14±0.03) vs (0.23±0.03)μg/kg], remifentanil [(13.56±2.35) vs (22.13±2.31)μg/kg] and propofol [(7.64±1.04) vs (9.01±1.18)mg/kg] were used in the former than the latter groups (P<0.05).Conclusion For CEA, ultrasound-guided SCP block combined with general anesthesia can improve short-term postoperative QoR-15 score, stabilize perioperative hemodynamics, decrease the dosages of anesthetics and vasoactive drugs, and reduce postoperative adverse events.
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