全身麻醉复合颈丛神经阻滞下行甲状腺手术中瑞芬太尼最小有效剂量的研究

发布时间：2018-04-29 06:06

本文选题：甲状腺疾病 + 自主神经传导阻滞　；参考：《临床合理用药杂志》2016年24期

【摘要】：目的探讨全身麻醉复合颈丛神经阻滞下行甲状腺手术中瑞芬太尼的最小有效剂量。方法选取2013年10月—2015年10月平罗县人民医院行甲状腺手术患者100例,按照随机数字表法将患者随机分为4组,每组25例。对照组泵入0.9%氯化钠溶液;试验1组泵入瑞芬太尼剂量为0.02μg·kg-1·min-1;试验2组泵入瑞芬太尼剂量为0.042μg·kg-1·min-1,试验3组泵入瑞芬太尼剂量为0.062μg·kg-1·min-1。比较4组患者5个时间段(麻醉前、麻醉后、手术开始、分离甲状腺及手术结束)生命体征变化情况〔平均动脉压(MAP)、血氧饱和度(Sp O2)、心率(HR)〕、OAA/S评分、术中配合情况。结果 MAP时间与方法间有交互作用(P0.05);MAP时间间比较,差异有统计学意义(P0.05);MAP组间比较,差异有统计学意义(P0.05)。Sp O2时间与方法间无交互作用(P0.05);Sp O2时间间比较,差异无统计学意义(P0.05);Sp O2组间比较,差异有统计学意义(P0.05)。HR时间与方法间无交互作用(P0.05);HR时间间比较,差异有统计学意义(P0.05);HR组间比较,差异有统计学意义(P0.05)。对照组患者分离甲状腺时MAP、HR高于麻醉前,差异有统计学意义(P0.05);试验1组、试验2组分离甲状腺时MAP、HR与麻醉前比较,差异无统计学意义(P0.05);试验3组分离甲状腺时MAP、HR低于麻醉前,差异有统计学意义(P0.05)。对照组患者OAA/S评分5级高于其他组,差异有统计学意义(P0.05);试验1组、试验2组患者OAA/S评分3~4级高于其他组,差异有统计学意义(P0.05);试验3组患者OAA/S评分1~2级高于其他组,差异有统计学意义(P0.05)。对照组术中配合优良率低于其他组,差异有统计学意义(P0.05);试验3组术中配合优良率高于其他组,差异有统计学意义(P0.05)。结论 0.02~0.04μg·kg-1·min-1是瑞芬太尼辅助全身麻醉复合颈丛神经阻滞下行甲状腺手术的最小有效剂量,用药安全。
[Abstract]:Objective to investigate the minimum effective dose of remifentanil in thyroid surgery under general anesthesia combined with cervical plexus block. Methods from October 2013 to October 2015, 100 patients undergoing thyroid surgery in Pingluo County people's Hospital were randomly divided into 4 groups, 25 cases in each group. The dose of remifentanil was 0.02 渭 g kg-1 min-1 in group 1, 0.042 渭 g kg-1 min-1 in group 2 and 0.062 渭 g kg-1 min-1 in group 3. The changes of vital signs (mean arterial pressure MAPP, blood oxygen saturation), heart rate (HRT) and OAA / S score were compared in 4 groups (before anesthesia, after anesthesia, beginning of operation, separation of thyroid gland and end of operation). Results there was a significant difference between MAP time and map time. The difference was statistically significant (P 0.05). The difference was significant (P 0.05) and there was no interaction between the methods (P 0.05) and SPO _ 2 (P < 0.05). There was no significant difference between the two groups, but there was no significant difference between the two groups. The difference was statistically significant (P 0.05). The time of HR was significantly different from the time of no interaction between the methods (P 0.05). The difference was statistically significant (P 0.05) and the difference was statistically significant (P 0.05). In the control group, the MAPHR of thyroid gland was higher than that before anesthesia, the difference was statistically significant (P 0.05); in group 1, there was no significant difference in MAPHR between group 2 and before anesthesia; in group 3, MAPHR was lower than that before anesthesia, and that in group 3 was lower than that before anesthesia. The difference was statistically significant (P 0.05). The OAA/S score of the control group was higher than that of the other groups, the difference was statistically significant (P 0.05), the OAA/S score of the test group 2 was higher than that of the other groups (P 0.05), the OAA/S score of the 3 groups was higher than that of the other groups. The difference was statistically significant (P 0.05). The excellent and good rate of intraoperative cooperation in the control group was lower than that in the other groups, the difference was statistically significant (P 0.05), and the excellent and good rate in the trial group was higher than that in the other groups (P 0.05). Conclusion 0.02nil 0.04 渭 g kg-1 min-1 is the minimum effective dose of remifentanil combined with cervical plexus nerve block for thyroid surgery.
【作者单位】：宁夏石嘴市平罗县人民医院麻醉科;
【分类号】：R614

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