气管内全麻合并颈丛阻滞应用于甲状腺手术的临床观察

Clinical Application of Inhalation-Intravenous General Anesthesia Combined with Cervical Plexus Block in the Thyroid Surgery

目的对比气管内全麻合并颈丛阻滞和单纯气管内全麻应用于甲状腺手术的麻醉效果。方法40例行双侧甲状腺次全切除手术的全麻患者,随机分为A、B两组,A组采用气管内全麻合并颈丛阻滞,B组采用单纯气管内全麻,常规麻醉诱导插管,麻醉维持A组用瑞芬太尼0.05～0.15μg/(kg·min),B组用瑞芬太尼0.1～0.2μg/(kg·min),两组均持续静脉输注异丙酚,记录气管插管、切皮、麻醉维持和气管拔管时血压和心率的变化,术后睁眼和气管拔管时间,以及术后是否需要镇痛。结果A组气管插管、切皮、麻醉维持时浅麻醉发生率明显低于B组(P<0.05),B组术后需要镇痛的人数明显多于A组(P<0.01)。结论气管内全麻合并颈丛阻滞在甲状腺手术时维持血流动力学稳定方面明显优于单纯气管内全麻,并可减轻术后疼痛。

Objective To explore the effect of inhalation-intravenous general anesthesia combined with cervical plexus block in the thyroid surgery. Methods 40 Patients having elective thyroid surgery under general anesthesia were allocated randomly into two groups： group A and group B, with 20 patients in each group, group A adopted inhalation- intravenous general anesthesia combined with cervical plexus block, group B adopted tracheal general anesthesia. After tracheal intubation, the depth of Anesthesia was maintained by remifentanil 0.05-0.15μg/（kg. min） in group A, and remifentanil 0.1-0.2μg/（kg-min） in group B, followed by an intravenous infusion of propofol. Heart rate and blood pressure were recorded at the following time points ： at intubation, skin incision, anesthetic maintenance and extubation. Eye opening after operation and exintubation time were also recorded. Postperative analgesia requirement was also noted. Results The rate of light anesthesia decreased significantly in group A than in group B during intubation, skin incision and anesthetic maintenance （P〈0.05）. Number of patients who need postoperative analgesia was high significantly in group B than in group A （P〈0.01）. Conclusion Hemodynamics are more stable in inhalation-intravenous general anesthesia combined with cervical plexus block in the thyroid surgery than in tracheal general anesthesia. Combines anaesthesia also can reduce postoperative pain.