氟比洛芬酯复合氟哌利多和哌替啶对颈丛神经阻滞下甲状腺手术患者应激反应的影响

Effect of flurbiprofen axetil combined with droperidol and pethidine on stress response in thyroid operation under cervical plexus block

目的:研究氟比洛芬酯复合氟哌利多和哌替啶对颈丛神经阻滞下甲状腺手术患者应激反应的影响.方法:ASAⅠ或Ⅱ级在颈丛阻滞下行甲状腺肿物切除术60例患者,分为3组(每组20例):氟比洛芬酯复合氟哌利多和哌替啶组(Ⅰ组),氟哌利多和哌替啶组(Ⅱ组),氟比洛芬酯组(Ⅲ组).采用3.75g/L罗哌卡因,10.0g/L利多卡因行颈丛神经阻滞成功后,Ⅰ组患者静脉注射氟比洛芬酯1mg/kg,肌注氟哌利多0.1mg/kg和哌替啶1mg/kg;Ⅱ组患者肌注氟哌利多0.1mg/kg和哌替啶1mg/kg;Ⅲ组患者静脉注射氟比洛芬酯1mg/kg.观察麻醉效果及并发症发生情况,记录麻醉前,切皮后30,60和90min的血压、心率和氧饱和度,检测麻醉前、切皮后30,60和90min的血清皮质醇、胰岛素和血糖水平.结果:三组患者麻醉前的血压、心率、血清皮质醇、胰岛素以及血糖浓度组间比较无统计学差异(P>0.05).Ⅱ组和Ⅲ组患者的血压、心率、血清皮质醇以及血糖浓度在切皮后30,60和90min与麻醉前比较均增高(P<0.05).切皮后30,60和90min,Ⅰ组患者的血压、心率、血清皮质醇以及血糖浓度低于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组和Ⅲ组的血压、心率、血清皮质醇以及血糖浓度相比无统计学差异(P>0.05).结论:颈丛神经阻滞复合氟比洛芬酯、氟哌利多和哌替啶能够减轻甲状腺手术时应激反应所导致的血流动力学、皮质醇和血糖水平变化.

AIM： To investigate the effect of flurbiprofen axetil combined with droperidol and pethidine on stress response in thyroid operation under cervical plexus block. METHODS ： Sixty patients （ASA Ⅰ or Ⅱ ） scheduled for excision of thyrophyma with cervical plexus block were randomly divided into 3 groups （20 in each group） ： flurbiprofen axetil combined with droperidol and pethidine group （group Ⅰ ）, droperidol and pethidine group （group Ⅱ ）, flurbiprofen axetil group （group Ⅲ）. After success cervical plexus block with 3.75 g/L ropivacaine and 10.0 g/L lidocaine, patients in group Ⅰ , Ⅱ or Ⅲ were administrated flurbiprofen axetil （1 mg/kg ） combined with droperidol （0. 1 mg/kg） and pethidine （ 1 mg/kg）, droperidol （0.1 mg/kg） and pethidine （1 mg/kg） or flurbiprofen axetil （1 mg/kg） , respectively. The efficacy and complications were observed. Blood pressure, heart rate, saturation of pulse oxygen （ SpO2 ） , cortisol, insulin and blood sugar level at defined time points （ before anesthesia, 30, 60 and 90 min after incision） were measured and compared. RESULTS： There was no significant difference among group Ⅰ , Ⅱ and Ⅲ in the levels of blood pressure, heart rate, SpO2, cortisol, insulin, blood sugar, efficacy of anesthesia and complications （P 〉0.05）. In the group Ⅱ and Ⅲ, the levels of blood pressure, heart rate, cortisol and blood sugar 30, 60 and 90 min after incision were higher than those in pre-anesthesia （ P 〈 0.05 ） and than those in group Ⅰ （ P 〈 0.05 ）. There was no significant difference between group Ⅱ and Ⅲ in the levels of blood pressure, heart rate, cortisol and blood sugar （P 〉 0. 05 ）. CONCLUSION： Cervical plexus block plus flurbiprofen axetil, droperidol and pethidine could relieve the changes of haemodvnamics, cortisol and blood sugar content resulted from stress response in the thyroid operation.