小剂量瑞芬太尼辅助颈丛神经阻滞的临床应用

Clinical Application of Low-dose Remifentanil as Adjuvant for Cervical Plexus Block Anesthesia

目的观察瑞芬太尼和度氟合剂抑制颈丛麻醉下甲状腺手术中牵拉反应的效果及不良反应,了解瑞芬太尼的安全性和有效性。方法选择甲状腺次全切手术者80例,ASAⅠ～Ⅱ级。用0.45%罗哌卡因+1%利多卡因行双侧颈丛麻醉后随机分为两组:A组为实验组,40例,术中持续微量泵入瑞芬太尼;B组为对照组,40例,辅予度氟合剂静脉注射。观察两组患者的VAS评分、镇静评分(OAA/S评分);并观察两组的术中、术后不良反应(呼吸循环影响、牵拉反应、恶心呕吐)。结果A组患者VAS评分0～3分,镇静评分4分,对呼吸无影响,无恶心、呕吐,术毕时患者意识清醒。B组患者VAS评分0～3分,镇静评分3～4分,亦无恶心、呕吐,但部分患者术毕时嗜睡。结论小剂量瑞芬太尼持续应用能强化颈丛麻醉效果,可控性好,优于度氟合剂,是颈丛麻醉较好的辅助剂。

Objective To observe the effects ofrcmifentanil and the mixture ofdolantin and pethidine in inhibition of cervical plexus anesthesia in thyroid surgery traction reaction and the adverse reactions to identify the safety and effectiveness of rcmifcntanil. Methods 80 cases of sub-total thyroidectomy patients, ASA I - II, were treated with 0.45% ropivacaine plus 1% lidocaine for bilateral cervical plexus anesthesia, who were randomly divided into two groups： Group A （ the experimental group）, 40 cases, for intraopcrative continuous infusion ofremifentanil minimally; Group B （the control group）, 40 cases, for intravenous infusion of mixture of dolantin and pcthidine auxiliarily, to observe VAS scores, sedation scores （OAA/S）, intraopcrative and postoperative adverse reactions （respiratory and circulatory effects, traction reaction, nausea and vomiting） in the two groups. Results Patients in Group A with VAS scores of 0 to 3 points, sedation scores of 4 points, had no effect on respiration, no nausea and vomiting, who were conscious when surgery completed; patients in Group B had VAS scores of 0 to 3 points, sedation scores of 3 to 4 points, no nausea and vomiting, but some patients had sleepiness when surgery completed. Conclusion Continuous application of low-dose rcmifentanil can improve the effects of cervical plexus anesthesia with good controllability, which is better than the mixture of dolantin and pethidine as a better adjuvant for cervical plexus anesthesia.