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

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。

Abstract:

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.