摘要
目的 探讨头皮神经阻滞联合全麻对开颅手术患者术后镇痛作用及围术期炎症反应的影响。方法 计算机检索Pubmed、EMbase、中国知网和万方数据库，手动检索相应参考文献，纳入头皮神经阻滞联合全麻用于开颅手术的临床随机对照试验，检索时间为自建库至2022年10月25日，检索语种为英文、中文。结果 共纳入26个研究，包括1721例患者。术后疼痛评分分别为术后6小时（SMD-1.23，95%CI -1.78～-0.67，P<0.0001，I2=91%）；术后12小时（SMD-2.34，95%CI -3.48～-1.19，P<0.0001，I2=97%）；术后24小时（SMD-0.63，95%CI -0.99～-0.26，P=0.0008，I2=88%）；术后48小时（SMD-0.68，95%CI -1.23～-0.13，P=0.02，I2=93%）。术前各炎症因子水平差异均无统计学意义，IL-6（术后6h：SMD-1.03，95%CI -1.39～-0.66，P<0.00001，I2=0.00%）；IL-10（术后24h：SMD1.02，95%CI 0.65～1.39，P<0.00001，I2=0.00%；术后48h：SMD1.06，95%CI 0.69～1.43，P<0.00001，I2=0.00%）；CRP（术后6h：SMD-0.9，95%CI -1.28～-0.51，P<0.00001，I2=41%；术后24h：SMD-1.41，95%CI -2.01～-0.81，P<0.00001，I2=72%；术后48h：SMD-1.26，95%CI -1.83～-0.68，P<0.0001，I2=71%）；术后24h吗啡消耗量（SMD-0.97，95%CI -1.88～-0.06，P=0.04，I2=91%）。术后恶心呕吐发生率（RR0.66，95%CI 0.49～0.91，P=0.01，I2=0%）。结论 头皮神经阻滞联合全麻可以减轻术后48小时内的疼痛程度，并能够抑制围术期炎症反应，有不确定的证据证明该方法可以减少术后24小时的吗啡用量，同时减低术后恶心呕吐的发生率。
关键词： 开颅手术；头皮神经阻滞；术后疼痛；应激反应；PONV；Meta分析
Abstract
Objective: To investigate the effect of scalp nerve block combined with general anesthesia on postoperative analgesia and perioperative inflammatory response in patients undergoing craniotomy. Methods Pubmed, EMbase, CNKI and Wanfang databases were searched by computer, and corresponding references were manually searched. Clinical randomized controlled trials of scalp nerve block combined with general anesthesia for craniotomy were included. The retrieval time was from the self-built database to October 25, 2022. The search languages are English and Chinese. Results A total of 26 studies including 1721 patients were included. Postoperative pain scores were 6 hours after surgery (SMD-1.23, 95%CI -1.78 to -0.67, P<0.0001, I2=91%). 12 hours after surgery (SMD-2.34, 95%CI -3.48 to -1.19, P<0.0001, I2=97%); 24 hours after surgery (SMD-0.63, 95%CI -0.99to -0.26, P=0.0008, I2=88%); 48 hours after operation (SMD-0.68, 95%CI -1.23 to -0.13, P=0.02, I2=93%). There were no significant differences in preoperative inflammatory factors . IL-6 (6h after operation:SMD-1.03, 95%CI -1.39 to -0.66, P<0.00001, I2=0.00%); IL-10 (24h after surgery: SMD1.02, 95%CI 0.65 to 1.39, P<0.00001, I2=0.00%; 48h after operation: SMD1.06, 95%CI 0.69 to 1.43, P<0.00001, I2=0.00%); CRP (6h after operation: SMD-0.9, 95%CI -1.28 to -0.51, P<0.00001, I2=41%; 24h after operation: SMD-1.41, 95%CI -2.01 to -0.81, P<0.00001, I2=72%; 48h after operation: SMD-1.26, 95%CI -1.83 to -0.68, P<0.0001, I2=71%); Morphine consumption at 24 hours after operation (SMD-0.97, 95%CI -1.88 to -0.06, P=0.04, I2=91%).The incidence of postoperative nausea and vomiting (RR0.66, 95%CI 0.49 to 0.91, P=0.01, I2=0%). Conclusion Scalp nerve block combined with general anesthesia can reduce the degree of pain within 48 hours after operation and inhibit perioperative inflammatory response. There is uncertain evidence that this method can reduce the dose of morphine at 24 hours after operation,It also reduces the incidence of postoperative nausea and vomiting.
Key words： Craniotomy; Scalp nerve block; Postoperative pain; inflammatory response; PONV; Meta analysis
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