《中国康复理论与实践》

《中国康复理论与实践》 ›› 2005, Vol. 11 ›› Issue (05): 388-389.

• 临床研究 • 上一篇    下一篇

头皮神经阻滞联合芬太尼降低切皮时交感神经反应的最低肺泡有效浓度

王立新; 王保国   

  1. 首都医科大学附属天坛医院麻醉科 北京市 100050
  • 收稿日期:2005-01-12 出版日期:2005-05-25 发布日期:2005-05-25

Scalp nerve block combined with intravenous fentanyl decrease MAC-BAR

WANG Li-xin, WANG Bao-guo   

  1. Departmentof Anesthesiology, Beijing Tiantan Hospital,100050 Beijing, China
  • Received:2005-01-12 Published:2005-05-25 Online:2005-05-25

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被引次数

6

摘要： 目的探讨神经外科手术前行头皮神经阻滞联合芬太尼在开颅期间减轻血流动力学反应的有效性。方法将43例行额颞部手术患者随机分为异氟醚组(I组)、异氟醚加芬太尼组(F组)、异氟醚联合头皮神经阻滞和芬太尼组(B组),通过“上下法”观察3组阻断切皮时交感神经反应的最低肺泡有效浓度(MAC-BAR)。结果I组、F组、B组阻断切皮时交感反应的肺泡浓度分别为2.0%、1.8%、1.0%,MAC-BAR分别为1.7MAC、1.55MAC、0.8MAC,B组比I组、F组降低(P<0.05)。结论手术前行头皮神经阻滞联合芬太尼可以明显减轻开颅期血流动力学变化。

关键词: 外周神经阻滞, 芬太尼, 开颅手术, 异氟醚, 最低肺泡有效浓度

Abstract: ObjectiveTo investigate the effects of intravenous fentanyl combined with scalp nerve block with ropivacaine on the hemodynamic response to skin incision during craniotomy.Methods43 ASA Ⅰ～Ⅱ patients scheduled for selective frontotemporal craniotomy were randomly assigned into 3 groups: the isoflurane group(group I,n=14), the fentanyl group (group F, n=15) and the fentanyl-ropivacaine group (group B, n=14 ).Anesthetic induction was performed with IV remifentanil 2 μg/kg, propofol 2 mg/kg, and vecuronium 0.1mg/kg. Group F received fentanyl 3 μg/kg 5 min before skin incision .Group B received the same doses of fentanyl prior to skin incision as well as scalp nerve block with 1% ropivacaine before induction. Anesthesia was maintained with isoflurane. The "up and down" method was used to determine MAC-BAR in each group.ResultsThe end-tidal isoflurane concentration blocking sympathetic response to incision in group I, F and B were 2.0%,1.8%,1.0% respectively.The MAC-BAR of group I, F and B were 1.7 MAC,1.55 MAC,0.8 MAC respectively. The end-tidal isoflurane concentration blocking sympathetic response to incision and MAC-BAR of group B decreased obviously compared with that of group I and F(P<0.05).ConclusionIntravenous fentanyl combined with scalp nerve block with ropivacaine can successfully reduce the hemodynamic response to skin incision.

Key words: peripheric nerve block, fentanyl, craniotomy, isoflurane, end-tidal isoflurane concentration