右美托咪啶辅助颈丛神经阻滞在甲状腺手术中的应用

The Application of Dexmedetomidine as a Supplement to Cervical Plexus Block for Thyroidectomy

目的观察右美托咪啶辅助颈丛神经阻滞在甲状腺手术中的应用。方法 60例甲状手术病人分为4组,每组15例,A组为生理盐水对照组;B组为氟芬合剂对照组;C、D组为右美托咪啶组,C组负荷量1μg/kg后以0.2μg/(kg.h)维持;D组负荷量后以0.7μg/(kg.h)维持。监测和记录病人颈丛神经阻滞前(T0)、颈丛阻滞后5min(T1)、10min(T2)、切皮时(T3)、分离甲状腺上极时(T4)、缝皮时(T5)的收缩压、舒张压、心率、心电图、脉搏血氧饱和度;在T0、T3、T4、T5评估镇静程度(Ramsay评分法);记录术中高血压、心动过速、心动过缓、低血压、呼吸抑制等不良反应的发生情况。结果 A、B两组麻醉后HR、SBP、DBP明显升高,C、D两组术中HR、SBP、DBP较平稳,差异有统计学意义(P<0.05)。C、D组T3、T4、T5的Ramsay评分较A、B组高(P<0.05),镇静效果好。4组均未见严重不良反应。结论两种右美托咪啶持续输注辅助颈丛神经阻滞麻醉应用于甲状腺手术时,病人的应激反应减轻,血压、心率平稳,术中镇静效果好,且无呼吸抑制。

Abstract Objective To observe the effect of dexmedetomidine infusion as a supplement to cervical plexus block for thyroidectomy. Methods Sixty thyroideetomy patients were divided randomly into four groups with 15 patients for each. In group A and B, patients got intraoperative continous infusion of 0.9% saline or mixture of fentanyl and droperidol auxiliarily as contral after anesthesia respectly. In group C and D, patients got a loading dose of 1 μg/（ kg · h） of dexmedetomidine then 0.2 μg/（ kg · h） or 0. 7μg/（ kg · h） intravenous dexmedetomidine. The changes of SBP, DBP, HR, SpO2 , Ramsay sedation scale were monitored and recored before cervical plexus（T0） ,5 minutes later（ T1 ）, 10 minutes later（ T2）, and at incision （ T3 ）, at separation of thyroid upper extreme （ T4 ） and at suture （ T5 ）. Advcse effects such as repiratory depression, hypotension or bradycardia were recored. Results The values of SBP, DBP, HR were significant higher in group A and B at T3, T4, TS. The values of SBP, DBP, HR were relatively stable in group C and D. （ P 〈 0. 05 ）. On time points of T3, T4 and T5, the Ramsay scales in group C and D were higher than those in group A and B. （ P 〈 0. 05 ）. There was no serious adverse reaction in the four groups. Conclusion Two dose of Dexmedetomidine as a supplement to cervical plexus block for thyroidectomy can effectively provide disirable blunting of blood pressure and heart rate, without respiratory depression,and produce better sedation.