全麻复合超声引导双侧颈浅丛阻滞在甲状腺切除术中的应用效果观察

发布时间：2018-05-14 14:55

本文选题：超声 + 颈丛神经阻滞　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:评价全麻复合超声引导双侧颈浅丛阻滞在甲状腺切除术中的应用效果。方法:择期甲状腺切除女性患者120例,ASA分级I-II级,年龄20-70岁,体重45-85kg。行全身麻醉诱导:依次静脉推注咪达唑仑0.03mg/kg、丙泊酚2mg/kg、舒芬太尼0.5ug/kg、维库溴铵0.05mg/kg,各组待睫毛反射消失后,可视喉镜插入喉返神经监测专用气管导管,行机械通气,吸入地氟醚维持麻醉。纳入患者随机分为四组,A组(n=30)行单纯全麻,术后使用PCIA泵,B(n=30)组单纯全麻,术后无PCIA泵,C组(n=30)、D组(n=30)于全麻后,经超声引导用0.33%罗哌卡因14ml行双侧颈浅丛阻滞(Bilateral superficial cervical plexus block,BSCPB),术后分别使用、未用PCIA进行镇痛。记录术中镇痛药物用量、术后48h疼痛、恶心呕吐(PONV)VAS评分及术后24h进食、排气、排便及床旁活动时间,基础值(麻醉前5min)、T1(插管后5min)、T2(开皮后10min)、T3(手术结束)、T4(拔管时)SBP、DBP、MAP、HR等指标数值。结果:A、B组在T1、T2、T3、T4的SBP、DBP、MBP、HR均较基础值明显升高(P0.05),C、D组在T1、T2、T3的SBP、DBP、MBP、HR均较基础值轻度升高(P0.05),在T4时刻较基础值显著升高(P0.05),两组间无明显统计学差异(P0.05),A、B两组与C、D两组间在T1、T2、T3时刻比较有显著差异(P0.05)。C、D两组术后疼痛VAS评分、术中舒芬太尼用量显著低于A、B组(P0.05),且B组术后VAS评分高于A组(P0.05),C、D两组间无统计学差异(P0.05)。A、B、C三组术后恶心呕吐评分显著高于D组,A、B组术后恶心呕吐程度更重(P0.05),B组术后恶心呕吐最为严重(P0.05)。A、B两组较C、D两组术后床旁活动所需时间长(P0.05),且A组床旁活动所需时间更长(P0.05)。C、D组在24小时内排气、排便例数显著高于A、B组(P0.05),且二者间无统计学差异(P0.05)。结论:全麻复合超声引导双侧颈浅丛阻滞较单纯全麻术中、术后镇痛和止吐效果更好,有利于维持术中循环稳定,降低术后并发症发生率,加快患者术后恢复。
[Abstract]:Objective: to evaluate the effect of combined general anesthesia and ultrasound guided bilateral superficial cervical plexus block in thyroidectomy. Methods: a total of 120 female patients with selective thyroidectomy were enrolled in this study. Their age was 20-70 years old and their weight was 45-85 kg. General anesthesia induction: intravenous injection of midazolam 0.03 mg / kg, propofol 2 mg / kg, sufentanil 0.5 mg / kg, vecuronium 0.05 mg / kg. After eyelash reflex disappeared, visual laryngoscope was inserted into a special tracheal tube for recurrent laryngeal nerve monitoring, and mechanical ventilation was performed. Inhalation of desflurane maintained anesthesia. The patients were randomly divided into four groups: group A (n = 30) received simple general anesthesia, group C (without PCIA pump C) and group D (n ~ (30) were treated with general anesthesia after general anesthesia. Bilateral superficial cervical plexus block with bilateral superficial cervical plexus block was performed with 0.33% ropivacaine 14ml under ultrasound guidance. No PCIA was used for analgesia. The dosage of analgesic during operation, pain 48 hours after operation, nausea and vomiting PONVVAS score, feeding, venting, defecation and bedside activity time at 24 hours after operation, basic value (5 min before anesthesia and T1 (5 min after intubation and T2 (10 min after extubation) (mitogen HR at extubation) were recorded. Results in T1 / T2T3 / T1 / T2 / T3 / T4 / T1 / T2 / T3 / T4 / T1 / T2 / T3 / T4 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / There was significant difference in VAS score of postoperative pain between the two groups. The dosage of sufentanil in group A was significantly lower than that in group A (P 0.05), and the postoperative VAS score in group B was higher than that in group A (P 0.05). The duration of bedside activity in group A was longer than that in group C and D, and the time required for bedside activity in group A was longer than that in group C (P 0.05). The number of defecation cases in group A was significantly higher than that in group A (P 0.05), and there was no statistical difference between the two groups (P 0.05). Conclusion: general anesthesia combined with ultrasound guided bilateral superficial cervical plexus block has better analgesic and antiemetic effects than that of simple general anesthesia, which is beneficial to maintain the stability of circulation during operation, reduce the incidence of postoperative complications, and accelerate the postoperative recovery.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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