颈浅丛神经阻滞复合全麻在甲状腺腺瘤手术中的应用

The application of combined superficial cervical plexus block and general anesthesia to the operations of thyorid gland tumour.

目的探讨颈浅丛神经阻滞复合全麻应用于甲状腺腺瘤手术的麻醉效果。方法 50例甲状腺腺瘤患者ASAⅠ～Ⅱ级,随机分为A、B两组,每组25例,A组患者用0.447%的罗哌卡因20ml行双侧颈浅丛神经阻滞,每侧10ml,待效果确定后行全麻诱导,两组患者诱导用药相同,咪达唑仑0.05μg/kg,芬太尼2μg/kg,异丙酚1.5μg/kg及维库溴铵0.1mg/kg,插入适合的气管导管,然后行机械控制呼吸。监测记录麻醉前、切皮、分离甲状腺及拔管时血压及心率。记录两组患者睁眼时间、拔管时间及术后是否需要镇痛。结果 B组切皮、分离甲状腺及拔管时血压及心率明显高于麻醉前(P<0.05),而A组各时段无明显变化(P>0.05)。A组麻醉复苏时间比B组短(P<0.05),B组术后需要镇痛人数明显多于A组(P<0.01)。结论颈浅丛神经阻滞复合全麻应用于甲状腺腺瘤手术,在维持术中血流动力学稳定、缩短术毕麻醉复苏时间,缓解术后疼痛等方面,效果明显优于单纯全麻。

Objective To observe the influence of combined superficial cervical plexus block and general anesthesia to the operations on thyorid gland tumour operations.Methods Fifty ASA Ⅰ or Ⅱ patients were randomly divided into group A and B,with 25 cases each.Each patient in group was provided bilateral superficial plexus block with 0.447% ropivacaine 20ml（10ml for each side） before general anesthesia induction.General anesthesia was induced with intravenous midazolam 0.05μg/kg,fentanyl 2μg/kg,propofol 1.5μg/kg and vecuronium 0.1mg/kg,then the appropriate endotracheal tube was inserted,breathing was controlled,SBP、DBP and HR was monitored and recorded at the time of Pre-anesthesia,skin incision.Performance of thyorid-detection and extubaetion.Eye opening after operation and exintubation were also recorded.Postperative analyesia requirement was also noted.Results Blood press and heart rates of group B were markedly increased during skin incision,performance of thyorid-detection and extubation（P0.05）,while there were no changes in group A（P0.05）,anesthesia recovery time of group A was than group B（P0.05）,number of patients who need postoperative analgesia was high significantly in group B than in group A（P0.01）.Conclusion The combination of superficial cervical plexus block and general anesthesia is significantly better than simple general anesthesia to thyroid gland tumour patients for its stabilized homodynamies、less frequency of anesthesia、the shorten of recovering and less requirement of postoperative analyesia.