全麻联合颈丛神经阻滞在甲状腺癌手术中的应用

发布时间：2018-08-20 15:42

【摘要】：目的:本研究通过观察不同麻醉方法在甲状腺癌手术中的应用,比较不同麻醉方法对患者血流动力学、BIS、用药量、呼吸恢复时间、苏醒时间、拔管时间、术后疼痛及术后并发症等方面的影响,以探究全麻联合颈丛神经阻滞在甲状腺癌手术中的应用效果,为甲状腺癌手术的麻醉提供一种好的选择。方法:选择60例需行甲状腺癌手术的患者分为观察组和对照组,每组30例。两组患者手术前半小时采用0.5mg阿托品与0.1g鲁米那钠进行肌注。对照组患者采用全麻,观察组患者采用超声引导下颈丛神经阻滞联合全麻。颈丛神经阻滞选用一针法,用1%利多卡因和0.375%罗哌卡因混合液作为局麻药物,穿刺在超声引导下进行,于患者的患侧颈深丛与颈浅丛分别注射8ml、4ml的药物,健侧颈浅丛用4ml局麻药物注射,阻滞后10min利用针刺法进行阻滞效果测试。阻滞完善后,及时麻醉诱导进行气管插管,诱导药物依次是咪达唑仑、舒芬太尼、丙泊酚、顺式阿曲库铵,以剂量分别为0.04-0.06mg/kg、0.4-0.6 ug/kg、2.0-2.5 mg/kg、0.15-0.2 mg/kg静注,在直视的情况下气管插管。两组患者的全麻维持都采用丙泊酚与维库溴铵持续泵入进行,手术结束待患者清醒后将气管导管拔除。分别记录所有患者手术全程中心率、血压、BIS、呼吸恢复时间、苏醒时间及拔管时间、麻醉药物用量以及术后4小时VAS评分。对比观察两种麻醉方式在患者(1)心率、血压、BIS值的变化;(2)麻醉药物的用量;(3)呼吸恢复时间、苏醒时间以及气管导管拔除时间;(4)术后4h VAS评分及术后并发症方面是否存在差异。采用a=0.05的检验水准,应用SPSS统计软件包进行分析。结果:观察组与对照组相比较,HR、SBP、DBP更稳定,存在统计学差异(P0.05);观察组患者BIS值波动与收缩压波动小于对照组,存在统计学差异(P0.05),但两组患者舒张压波动与HR波动不存在统计学差异(P0.05);观察组患者呼吸恢复时间、苏醒时间及拔管时间显著早于对照组(P0.01);观察组患者全麻药物的用量少于对照组,存在统计学显著性差异(P0.05);与对照组患者相比,观察组患者的术后4h VAS评分降低(P0.05),术后并发症中的咽喉不适和恶心呕吐发生率明显减少(P0.05)。结论:甲状腺癌手术的麻醉中,全麻联合颈丛神经阻滞对患者血流动力学影响小,术中对患者造成的应激反应小,机体各项指标平稳,波动幅度较小,苏醒快,拔管早,术后疼痛较轻,术后并发症较少,有利于患者术后恢复。
[Abstract]:Objective: to observe the application of different anesthetic methods in thyroid cancer surgery, and to compare the effects of different anesthetic methods on the hemodynamics of patients with BIS, the dosage of drugs, the time of respiratory recovery, the time of extubation. In order to explore the effect of general anesthesia combined with cervical plexus nerve block in the operation of thyroid cancer, the effect of postoperative pain and postoperative complications was discussed, which provided a good choice for the operation of thyroid cancer. Methods: 60 patients with thyroid carcinoma were divided into observation group and control group with 30 cases in each group. Patients in both groups were given intramuscular injection of 0.5mg atropine and 0.1 g roumina sodium half an hour before operation. The patients in the control group were treated with general anesthesia, and the patients in the observation group were treated with cervical plexus nerve block combined with general anesthesia under the guidance of ultrasound. The cervical plexus nerve block was performed with 1% lidocaine and 0.375% ropivacaine as local anesthetic. The puncture was conducted under the guidance of ultrasound. The patients were injected with 8ml of 4 ml of drug in the deep cervical plexus and superficial cervical plexus, respectively. The contralateral superficial cervical plexus was injected with 4ml local anesthetic, and the effect of 10min was tested by acupuncture after block. After the block was completed, tracheal intubation was induced in time. Midazolam, sufentanil, propofol, cis-atracurium were given intravenously at doses of 0.04-0.06 mg / kg 0.4-0.6 mg 路kg ~ (-1) 路kg ~ (-1) -2.0-2.5 mg / kg 路kg ~ (-1) 0.15-0.2 mg/kg respectively. Propofol and vecuronium were used to maintain general anesthesia in both groups. Tracheal catheter was removed after operation. The central rate, blood pressure, respiratory recovery time, recovery time and extubation time, anesthetic dosage and VAS score were recorded in all patients. The changes of heart rate, blood pressure and BIS were compared between the two anesthesia methods. (2) the dosage of anesthetic drugs; (3) respiratory recovery time, recovery time and tracheal catheter extubation time; (4) whether there were differences in VAS scores and postoperative complications at 4 hours after operation. The test level of A0. 05 was used and the analysis was carried out by SPSS statistical software package. Results: compared with the control group, the observation group was more stable than the control group (P0.05), the fluctuation of BIS and systolic blood pressure in the observation group was smaller than that in the control group. There was statistical difference (P0.05), but there was no significant difference between the two groups in diastolic blood pressure fluctuation and HR fluctuation (P0.05). The recovery time and extubation time were significantly earlier than that of the control group (P0.01); the dosage of general anesthesia in the observation group was less than that in the control group, there was significant difference (P0.05); compared with the control group, In the observation group, the VAS score decreased at 4 hours after operation (P0.05), and the incidence of pharyngolaryngeal discomfort and nausea and vomiting in postoperative complications decreased significantly (P0.05). Conclusion: general anesthesia combined with cervical plexus block has little effect on hemodynamics in patients with thyroid carcinoma. The stress response to patients during operation is small, the body indexes are stable, the fluctuation is small, the recovery is fast, and the extubation is early. Postoperative pain is less and postoperative complications are less, which is beneficial to postoperative recovery.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R736.1

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