小剂量咪唑安定、异丙酚和芬太尼合用于颈丛阻滞甲状腺手术的应用

Application of small-dose Midazolam combined with Propofol and Fentanyl in thyroidectomy under cervical plexus block

目的：通过观察小剂量的咪唑安定、异丙酚和芬太尼合用于颈丛阻滞甲状腺手术的镇静、遗忘、并发症及术中血液动力学变化等,探讨其临床应用。方法：选择美国麻醉协会（ASA）麻醉分级,也称为麻醉分级的Ⅰ-Ⅱ级择期甲状腺手术患者60例,随机分成对照组（A组）和观察组（B组）,每组30例。B组患者于颈丛阻滞前5min缓慢静注咪唑安定1.5～2.0mg,颈丛阻滞后微量泵输注异丙酚3mg/（kg·h）、芬太尼1.125μg/（kg·h）。A组患者在手术开始前缓慢静注异丙酚1 mg/kg、芬太尼0.05mg,继以异丙酚4～6mg/（kg·h）输注维持。监测并记录入室时（T0）、颈丛阻滞后10min（T1）、20min（T2）、30min（T3）、手术开始后30min（T4）及术毕（T5）时的BP、HR和SpO2,并计算MAP。观察并记录两组患者的不良反应及术后遗忘程度。结果：与T0比较,A组患者在T1、T2、T3时MAP显著升高、HR显著加快（P〈0.01）,B组患者术中MAP、HR变化不明显（P〉0.05）;B组MAP、HR在T1、T2、T3时明显低于A组（P〈0.01）。A组呼吸暂停发生率（36.7%）明显高于B组（0%）（P〈0.01）。B组患者术后颈丛阻滞操作遗忘率和手术过程的Ⅲ级遗忘率高于A组（P〈0.01）。结论：小剂量的咪唑安定、异丙酚和芬太尼合用于颈丛阻滞甲状腺手术,镇静效果满意,能有效抑制颈丛阻滞后的心血管反应,对患者呼吸循环功能影响小,不良反应少,术后对颈丛阻滞操作和手术过程遗忘作用强,可提高患者的麻醉质量。

Objective： To observe effects of small-dose midazolam combined with propofol and fentanyl on sedation,amnesia,complications,hemodynamic changes and the like in thyroidectomy under cervical plexus block,and investigate its clinical applications. Methods： Sixty American society of anesthesiology（ ASA） I- II patients with elective thyroidectomy were randomly divided into control group（ group A,n = 30） and observation group（ group B,n = 30）. The patients in group B received midazolam 1. 5- 2. 0 mg before cervical plexus block through slow intravenous injection,following maintenance dose of propofol 3mg /（ kg·h） and fentanyl 1.125μg /（ kg·h） after cervical plexus block through micropump infusion. The patients in group A received propofol 1mg /kg and fentanyl 0. 05 mg as loading dose before the start of operation through slow intravenous injection,following the maintenance dose of propofol 4 ～ 6mg /（ kg·h）. BP,HR and SpO2 were monitored and recorded at the baseline（ T0）,10 min（ T1）,20min（ T2）,30min（ T3）after cervical plexus block,30min（ T4） after the start of operation,and at the end of operation（ T5）; then MAP was calculated. At the same time,the side effects and incidence of amnesia were recorded. Results： In group A,MAP and HR significantly increased at T1,T2 and T3 compared with those at T0（ P〈0. 01）. MAP and HR from T1 to T5 had no change in group B compared with those at T0（ P〉0. 05）. MAP and HR were lower in group B at T1,T2 and T3 than those in group A（ P〈0. 01）. The incidences of apnea in group A（ 36. 7%） was significantly higher than that in group B（ 0%）（ P〈0. 01）. The incidences of amnesia of cervical plexus block and operation in group B were higher than those in group A（ P〈0. 01）. Conclusions： Small- dose of midazolam combined with propofol and fentanyl is suitable for sedation and amnesia for the patients with thyroidectomy under cervical plexus block,has satisfactory sedative effects and no adverse reactions,could effectively prevent the cardiovascular response of cervical plexus block,has less effects on the respiratory and circulatory function,has great effects on amnesia of cervical plexus block and operation,and can improve anesthesia quality.