Observations on Hemodynamics and Stress Response of the Different Anesthesia Methods in Stereotactic Intracranial Hematoma Removal for Hypertensive Intracerebral Hemorrhage
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摘要:
目的 探讨高血压脑出血立体定向颅内血肿清除术中不同麻醉方式对血流动力学及应激反应的影响。 方法 选取2020年4月至2021年12月在邯郸市中心医院及河北医科大学第二医院接受立体定向颅内血肿清除术的80例高血压脑出血患者纳入研究对象，按随机数字表法分为观察组与对照组，各40例。观察组患者在立体定向颅内血肿清除术前给予头皮神经阻滞麻醉，对照组患者在立体定向颅内血肿清除术前给予局部浸润麻醉。比较2组患者在麻醉前（T0）、切头皮时（T1）、钻孔时（T2）、缝合时（T3）的平均动脉压（MAP）、心率（HR）、皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E），比较2组患者术后1 h、6 h、12 h的疼痛程度，比较2组患者手术前后的格拉斯哥昏迷评分（GCS）评分、神经功能缺损评分（CCS）评分。 结果 对照组在T1、T2、T3时点MAP、HR显著高于T0时（P < 0.05），观察组在T1、T2、T3时点MAP、HR显著低于对照组（P < 0.05）；观察组在T1、T2、T3时点Cor、NE、E显著低于对照组（P < 0.05），对照组在T1、T2、T3时点Cor、NE、E显著高于T0时（P < 0.05）；观察组在术后1 h、6 h、12 h的疼痛数字评价量表（NRS）评分均显著低于对照组（P < 0.05）；2组术后3 d的GCS评分显著高于术前，CCS评分显著低于术前（P < 0.05）。 结论 高血压脑出血患者立体定向颅内血肿清除术中采用头皮神经阻滞麻醉血流动力学更稳定，应激反应程度更轻。 -
关键词:
- 高血压脑出血 /
- 立体定向颅内血肿清除术 /
- 麻醉 /
- 血流动力学 /
- 应激反应
Abstract:Objective To explore the effect of different anesthesia methods on the hemodynamics and stress response during the stereotactic intracranial hematoma removal of the hypertensive cerebral hemorrhage. Methods 80 patients who underwent the stereotactic intracranial hematoma removal in with the hypertensive intracerebral hemorrhage Handan Central Hospital and the Second Hospital of Hebei Medical University from April 2020 to December 2021 were selected into the study. They were randomly divided into the observation group and the control group, with 40 cases in each group. The patients in the observation group were given the scalp nerve block anesthesia before the stereotactic intracranial hematoma removal, and the patients in the control group were given the local infiltration anesthesia before the stereotactic intracranial hematoma removal. The mean arterial pressure （MAP）, heart rate （HR）, cortisol （COR）, norepinephrine （NE） and epinephrine （E） were compared between the two groups before the anesthesia （T0）, scalp cutting （T1）, drilling （T2） and suture （T3）. The pain levels of the two groups of patients were compared at 1 h, 6 h, and 12 h after the surgery, and the Glasgow Coma Score （GCS） score and neurological impairment score （CCS） scores of the two groups before and after the operation were compared. Results The MAP and HR of the control group at T1, T2, and T3 were significantly higher than those at T0 （P < 0.05）, and the MAP and HR of the observation group at T1, T2, and T3 were significantly lower than those of the control group （P < 0.05）. Cor, NE and E of the observation group at T1, T2, and T3 were significantly lower than those of the control group （P < 0.05）. In the control group, Cor, NE and E at T1, T2 and T3 were significantly higher than those at T0 （P < 0.05）. The numerical pain rating scale （NRS） scores of the observation group at 1 h, 6 h, and 12 h after the surgery were significantly lower than those of the control group （P < 0.05）. The GCS scores of the two groups were significantly higher at 3 days after the surgery, and the CCS scores were significantly lower than those before the surgery （P < 0.05）. Conclusion The scalp nerve block anesthesia in the stereotactic removal of intracranial hematoma in patients with the hypertensive intracerebral hemorrhage has more stable hemodynamics and less stress response. -
表 1 2组一般资料比较[n（%）/
$\bar x \pm s$ ]Table 1. Comparison of general data between the two groups [n（%）/
$\bar x \pm s$ ]项目 观察组（n = 40） 对照组（n = 40） χ2/t P 性别（n） 男 23（57.50） 25（62.50） 0.208 0.648 女 17（42.50） 15（37.50） 年龄（岁） 56.49 ± 7.34 56.08 ± 7.60 0.245 0.807 发病至手术时间（h） 55.57 ± 6.44 55.22 ± 6.19 0.248 0.805 血肿部位（n） 基底调节区 17（42.50） 19（47.50） 0.402 0.940 小脑 3（7.50） 2（5.00） 脑叶 6（15.00） 5（12.50） 丘脑 14（35.00） 14（35.00） 血肿量（mL） 40.16 ± 3.24 40.68 ± 3.07 0.737 0.463 意识状态（n） 意识清醒 6（15.00） 4（10.00） 0.688 0.876 昏迷 3（7.50） 4（10.00） 昏睡 18（45.00） 20（50.00） 嗜睡 13（32.50） 12（30.00） GCS评分（分） 8.87 ± 1.38 8.99 ± 1.74 0.342 0.734 ASA分级（n） Ⅱ级 36（90.00） 35（87.50） 0.125 0.723 Ⅲ级 4（10.00） 5（12.50） 
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表 2 2组不同时点血流动力学比较（
$\bar x \pm s $ ）Table 2. Comparison of hemodynamics between the two groups at different time points （
$\bar x \pm s $ ）指标 时点 观察组（n = 40） 对照组（n = 40） t P MAP（kPa） T0 13.89 ± 2.17 13.79 ± 2.33 0.198 0.843 T1 14.71 ± 2.28 17.56 ± 3.13# 4.660 < 0.001 T2 14.92 ± 2.62 19.42 ± 3.62# 6.364 < 0.001 T3 14.68 ± 2.55 18.31 ± 3.14# 5.683 < 0.001 F 1.409 24.996 P 0.242 < 0.001 HR（次/min） T0 69.18 ± 8.47 69.60 ± 8.44 0.225 0.823 T1 71.05 ± 8.32 87.25 ± 9.20# 8.259 < 0.001 T2 72.15 ± 8.63 90.35 ± 9.87# 8.780 < 0.001 T3 71.05 ± 8.05 89.43 ± 9.11# 9.558 < 0.001 F 0.868 45.617 P 0.459 < 0.001 与本组T0比较，#P < 0.05。
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表 3 2组不同时点应激指标比较（
$\bar x \pm s $ ）Table 3. Comparison of stress indicators between the two groups at different time points （
$\bar x \pm s $ ）指标 时点 观察组（n = 40） 对照组（n = 40） t P Cor（mmol/L） T0 361.08 ± 42.52 360.44 ± 39.87 0.069 0.945 T1 372.28 ± 43.16 461.34 ± 56.56# 7.917 < 0.001 T2 380.57 ± 47.61 475.15 ± 57.84# 7.985 < 0.001 T3 374.83 ± 44.29 467.69 ± 56.91# 8.144 < 0.001 F 1.355 41.184 P 0.259 < 0.001 NE（mmoL/L） T0 2.03 ± 0.31 1.95 ± 0.29 1.192 0.237 T1 2.06 ± 0.22 2.77 ± 0.34# 11.088 < 0.001 T2 2.17 ± 0.33 3.06 ± 0.40# 10.855 < 0.001 T3 2.08 ± 0.23 2.60 ± 0.38# 7.404 < 0.001 F 1.898 70.134 P 0.132 < 0.001 E（ng/mL） T0 0.85 ± 0.18 0.82 ± 0.16 0.788 0.433 T1 0.88 ± 0.15 1.20 ± 0.14# 9.864 < 0.001 T2 0.90 ± 0.19 1.25 ± 0.24# 7.231 < 0.001 T3 0.87 ± 0.13 1.23 ± 0.13# 12.384 < 0.001 F 0.643 55.828 P 0.589 < 0.001 与本组T0比较，#P < 0.05。
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表 4 2组术后疼痛程度比较[（
$\bar x \pm s $ ），分]Table 4. Comparison of postoperative pain degree between two groups [（
$\bar x \pm s $ ），Points]时点 观察组（n = 40） 对照组（n = 40） t P n 40 40 术后1 h 4.30 ± 1.79 5.75 ± 2.26 3.182 0.002 术后6 h 2.98 ± 1.33# 4.63 ± 1.61# 4.993 < 0.001 术后12 h 2.03 ± 0.95#△ 3.18 ± 1.13#△ 4.934 < 0.001 F 25.543 22.195 P < 0.001 < 0.001 与本组术后1 h比较，#P < 0.05；与本组术后6 h比较，△P < 0.05。
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表 5 2组手术前后GCS评分、CCS评分比较[（
$\bar x \pm s $ ），分]Table 5. Comparison of GCS score and CCS score before and after surgery between the two groups [（
$\bar x \pm s $ ），Points]指标 时点 观察组（n = 40） 对照组（n = 40） t P GCS评分 术前 7.68 ± 1.12 7.33 ± 1.07 1.429 0.157 术后3 d 12.30 ± 1.42 11.78 ± 1.35 1.697 0.094 t 16.156 16.338 P < 0.001 < 0.001 CCS评分 术前 18.53 ± 3.29 19.03 ± 3.51 0.657 0.513 术后3 d 9.18 ± 2.27 10.05 ± 2.48 1.644 0.104 t 14.794 13.215 P < 0.001 < 0.001
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