右美托咪定联合超声引导下颈丛神经阻滞在甲状腺手术中的临床研究

发布时间：2018-01-31 19:57

本文关键词： 右美托咪定颈丛神经阻滞甲状腺手术　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察右美托咪定联合超声引导下颈丛神经阻滞在甲状腺手术中的疗效，比较该法与全身麻醉在甲状腺手术中运用中的优缺点，为甲状腺手术的麻醉提供一种选择。方法：拟择期行甲状腺病灶切除术(年龄18～65岁，男女不限，ASA分级I～II级)的患者60例，分成2组，每组30例。I组为右美托咪啶右美托咪啶联合颈丛神经阻滞组；II组全身麻醉组。术前访视病人，交待术前注意事项，取得患者及家属配合。患者入手术后，常规开放上肢静脉，两组患者均给予1.0ug/kg右美托咪啶泵注，10分钟内注射完毕，之后按0.1ug/kg/min速度持续泵注，直至手术结束。实验组在超声引导下行手术侧颈深、颈浅丛阻滞，分别注入1%利多卡因与0.5%罗派卡因混合液各5mL，，对侧行颈浅神经阻滞，注入1%利多卡因与0.5%罗派卡因混合液5mL。手术医生洗手、穿无菌衣，3分钟后切皮。切皮前静脉注射芬太尼0.05mg。记录患者入室（泵注DEX前）（T0）、神经阻滞前（泵注DEX后）（T1）、神经阻滞后、（T2）、切皮后（T3）SBP、DBP、HR。对照组行静脉麻醉诱导，静脉推注芬太尼3-5ug/kg、丙泊酚2-2.5mg/kg、阿曲库胺1mg/kg(2倍ED95)，行快速经口明视下气管插管，接麻醉机，固定气管导管，丙泊酚4-10mg/kg/h、阿曲库胺0.3-0.6mg/kg/h、瑞芬太尼0.2ug/kg/min麻醉维持。记录患者入室（泵注DEX前）（T0）、全麻诱导前（泵注DEX后）（T1）、全麻诱导后、（T2）、切皮后（T3）SBP、DBP、HR。术中记录实验组Ramsay评分，观察患者发声情况，观察患者是否出现不适症状。术后分别记录两组麻醉总费用，术后24小时、48小时内对患者行术后随访，随访内容包括两组患者伤口引流量、术后恶心呕吐、声音嘶哑情况。结果： 1、两组病人性别构成比、年龄、体重、ASA分级、病灶大小差异无统计学意义（P0.05）； 2、两组病人T0时间点SBP、DBP、HR差异无统计学意义（P0.05）； 3、颈丛组病人T1、T2时间点相对T0时间点SBP、DBP、HR差异无统计学意义（P0.05）；T3时间点相对T2时间点SBP、DBP、HR差异无统计学意义（P0.05）； 4、全麻组病人T1时间点相对T0时间点SBP、DBP、HR差异无统计学意义（P0.05）；T2时间点相对T0时间点SBP、DBP、HR差异有统计学意义（P0.05）；T3时间点相对T2时间点SBP、DBP、HR差异有统计学意义（P0.05）； 5、颈丛组患者，术中镇静效果佳； 6、两组病人喉返神经损伤发生率无差异（P0.05），均为0； 7、两组病人术后切口引流量差异无统计学意义（P0.05）； 8、颈丛组麻醉费用较全麻组麻醉费用低，差异有统计学意义（P0.05）； 9、颈丛组患者术后咽部不适感、恶心呕吐发生率较全麻组低，差异有统计学意义（P0.05）；结论：在本试验条件下，右美托咪定联合超声引导下颈丛神经阻滞适合甲状腺手术。患者在充分镇静的情况下，可以很好的配合术者行神经学检查。相对全身麻醉，该方法可使患者血流动力学更加稳定，麻醉费用减少，节省医疗资源，术后并发症减少。两种麻醉方法下，喉返神经损伤率未见差异。
[Abstract]:Objective: To observe the efficacy of dexmetomidine combined with ultrasound guided cervical plexus nerve block in thyroid surgery, and to compare the advantages and disadvantages of this method with that of general anesthesia in thyroid surgery. Provides an option for anesthesia in thyroid surgery. Methods: Sixty patients with thyroid lesion resection (18 ~ 65 years old, male and female) undergoing selective thyroidectomy were divided into two groups. 30 cases in each group were treated with dexmetidine combined with cervical plexus nerve block. Group II: general anesthesia group. Visit the patients before operation, explain the matters needing attention before operation, obtain the cooperation of the patients and their families. After the patients were operated on, the upper limb veins were routinely opened. The patients in both groups were given 1.0ug-kg dexmetidine for 10 minutes and then continued at the rate of 0.1ugP / kg / min. Until the end of the operation, the experimental group was guided by ultrasound under the operation side cervical deep, superficial cervical plexus block, respectively injected 1% lidocaine and 0.5% ropivacaine mixture of 5 mL, the opposite side of the superficial cervical nerve block. A mixture of 1% lidocaine and 0.5% ropivacaine was injected 5 mL. The surgeon washed his hands and wore a sterile coat. After 3 minutes of incision, fentanyl was injected intravenously with 0.05mg. the patients were recorded before and after DEX injection, and before nerve block (after DEX was injected with DEX), after nerve block. The control group was induced by intravenous anesthesia. Fentanyl 3-5ug-% kg and propofol 2-2.5mg / kg were injected intravenously. Atracuramide (1 mg / kg) 2 times ED95 / L, followed by rapid intubation through open vision, anaesthesia, fixation of trachea catheter, propofol 4-10 mg / kg / h. Anesthesia of atracuramide 0.3-0.6 mg / kg / h, remifentanil 0.2 ugr / kg / min was maintained. Patients were recorded in room (T0 before DEX was injected). Before the induction of general anesthesia (after DEX was injected by pump, after induction by general anesthesia, the patients were treated with T2, and the Ramsay scores of the experimental group were recorded during the operation. The total cost of anaesthesia was recorded after operation. The patients were followed up within 24 hours and 48 hours after operation. The follow-up included wound drainage, postoperative nausea and vomiting, and hoarseness. Results: 1. There was no significant difference in sex composition ratio, age, weight and ASA grade between the two groups, and there was no significant difference in lesion size between the two groups (P 0.05). (2) there was no significant difference in HR between the two groups at T0 time point (P 0.05); 3. There was no significant difference in HR between T _ 1 T _ 2 and T _ 0 time points in patients with cervical plexus. There was no significant difference in HR between T _ 3 time point and T _ 2 time point compared with that at T _ 2 time point. 4. There was no significant difference in HR between T 1 time point and T 0 time point in general anesthesia group (P 0.05). The difference of HR between T 2 time point and T 0 time point was statistically significant (P 0.05). The difference of HR between T 3 time point and T 2 time point was statistically significant (P 0.05). 5. In the cervical plexus group, the sedation effect was good during the operation. There was no difference in the incidence of recurrent laryngeal nerve injury between the two groups (P 0.05). There was no significant difference in incision drainage between the two groups (P 0.05). The cost of anesthesia in the cervical plexus group was lower than that in the general anesthesia group, and the difference was statistically significant (P 0.05). The incidence of postoperative pharynx discomfort and nausea and vomiting in the cervical plexus group was lower than that in the general anesthesia group (P 0.05). Conclusion: Under this condition, dexmetomidine combined with ultrasound guided cervical plexus nerve block is suitable for thyroid surgery. This method can make the hemodynamics of patients more stable, reduce the cost of anesthesia, save medical resources and reduce postoperative complications. There is no difference in the injury rate of recurrent laryngeal nerve between the two methods.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R653

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