局麻药加地塞米松行浅颈丛阻滞麻醉的临床观察

Clinical observation on the effect of superficial cervical plexus blocking anesthesia plus local anesthetics for surgical treatment of patients with thyroid adenoma.

目的观察甲状腺腺瘤切除术采用局麻药加地塞米松行浅颈丛阻滞麻醉的临床效果。方法40例甲状腺腺瘤切除术患者随机分成两组,Ⅰ组局麻药加地塞米松10mg,Ⅱ组局麻药不加任何药,均行双侧颈浅丛阻滞,术中有牵拉不适辅助强化麻(氟哌啶2.5mg+芬太尼0.05mg静脉滴注),仍无法缓解辅助静脉全麻(异丙酚200mg加芬太尼0.1mg混合液泵注)。观察麻醉前后血压、心率的变化,术毕评定麻醉效果。结果麻醉后两组血压、心率较麻醉前比均差异有显著性(P<0.05或P<0.01),但从升高数值上看,全组40例血压、心率变化均在正常值范围内;Ⅰ组麻醉效果明显优于Ⅱ组,Ⅰ组中无1例需辅助静脉全麻。结论浅颈丛阻滞应用于甲状腺腺瘤切除术,发生心血管副反应程度低,加用地塞米松,可增强麻醉效果,患者能清醒配合手术,提高了麻醉和手术的安全性。

Objective To observe the clinical effect of superficial cervical plexus blocking anesthesia with local anesthesia plus dexamethasone in surgical treatment of patients with thyroid adenoma. Methods Forty thyroid adenoma patients were randomly divided into Group I and Group II. Local anesthesia plus 10mg of dexamethasone was used for surgical treatment of patients in Group I, while local anesthesia along was used in Group II without use of dexamethasone. Superficial cervical plexus blocking anesthesia on both sides were performed during the operation and intensified anesthesia was applied on those feeling uncomfortable due to traction during the operation (2.5mg of doperidol-2 plus 0.05mg of stag and fentanyl were given intravenously). General anesthesia was used on those without relieving during operation (the mixture of 200mg of propofol and 0.1mg of fentanyl was used by pumping injection) The variations of blood pressure and heart rate were observed before and after the operation and anesthetic results were assessed completion of surgical treatment. Results Significant differences in blood pressure and heart rate before and after the operation were observed in the two groups (P<0.05 and P<0.01). It was noticed that the values of blood pressure and heart rate of the 40 patients were in the normal range. The anesthesia results in Group I was obviously superior to Group II and no general anesthesia was required for patients in Group I. Conclusion The extent of occurrence of adversary reactions in cardiovascular was low by applying superficial cervical plexus blocking anesthesia in surgical treatment of patients with thyroid adenoma, the anesthetic effect can be strengthened by addition of dexamethasone and the safety of operational and anesthesia can be enhanced as the patients was clear during operation and cooperate with the doctor.