不同剂量舒芬太尼对颈丛阻滞甲状腺切除术患者的作用

Effects of different doses of sufentanil in patients undergoing thyroidectomy with cervical plexus block

目的观察舒芬太尼在颈丛阻滞甲状腺切除术中的应用效果。方法 80例ASAⅠ～Ⅱ级甲状腺切除患者随机双盲分为4组（每组20例）：S1组0．10ug／kg舒芬太尼；S2组0．15ug／kg舒芬太尼；S3组0．20ug／kg舒芬太尼，C组（对照组）生理盐水，于手术开始前5min静脉缓慢静注药物；记录手术前（T0）、手术开始（T1）、分离颈白线（T2）、分离腺体（T3）、处理上级（T4）、切除腺体（T5）等各时间段的SBP、DBP、MAP、HR、RR、SPO2、ECG，视觉模拟评分（VSA）评价术中疼痛程度，Ramsay评分评价镇静程度和不良反应等。结果C组T3、T4时SBP、DBP、MAP、HR高于S2、S3组（P〈0．05），C组T3、T4、T5时SBP、MAP、HR高于T0、T1时（P〈0．05）；S1组SBP、MAP、在T3、T4时高于S2组、S3组（P〈0．05）；VAS评分：T1、T4时S2、S3组明显优于C组、S1组（P〈0．05）；Ramsay评分：T3、T4、T5时S2、S3组明显优于C组、S1组（P〈0．05）。不良反应：S3组恶心2例、呕吐1例、一过性呼吸抑制6例。结论0．15ug／kg舒芬太尼辅助颈丛阻滞行甲状腺切除术，可使患者达到充分的镇静、镇痛作用，且不增加不良反应。

Objective To observe the effects of different doses of sufentanil in patients undergoing thyroidectomy with cervical plexus block. Methods Eighty ASA class Ⅰ or Ⅱ patients undergoing thyroidectomy with cervical plexus block were divided into 4 groups （ n = 20）. They received sufentanil iv 0. 10 ug/kg （group S1 ）, 0.15 ug/kg （ group S2） ,0.20 ug/kg （ group S3 ）, 0.9% sodium chloride （ group C） ,at 5 min before operation separately. SBP, DBP, MAP, HR, RR, SPO2, ECG were recorded, visual analog score （VSA） was used for evaluation of pain,ramsay sedation score was used to evaluate side effects at the 5 min before the operation [ T0 ] ）, the beginning of the operation （ T1 ）, the separation of neck white lines （T2） , separation of glands （T3 ） , the higher level processing （T4 ） , removal the gland （T5）. Results The SBP, DBP, MAP, HR of group C were higher than group S2 and group S3 （P 〈 0.05） ;The SBP, MAP, HR of group C at T3 , T4 , T5 were higher than at To, T4 （ P 〈 0.05 ） ; The SBP, MAP, HR of group S1 at T3 and T4 were higher than group S2 and group S3; the difference between group $2 and gropu S3 at all time points was not statistically significant. VAS scores at T3 , T4 in group S2, S3 were superior to those in group C and group S1 （P 〈0.05） ; the difference between group S2 and S3 at all time points was not statistically significant. Ramsay sedation scores at T3, T4, T5 of group S2 and group S3 were better than those of group C and group S1 ; the difference between group S2 and S3 at all time points was not statistically significant. There were group two cases in of nausea, vomiting in one case, respiratory depression in six cases in S3 group. Conclusion 0.15 ug/kg sufentanil adapt to the patients undergoing thyroidectomy with cervical plexus block has reliable effects of analgesic and sedation and there is no increase of the adreres effect.