颈丛阻滞复合瑞芬太尼及丙泊酚清醒镇静麻醉用于甲状腺手术的临床观察

Clinical observation of cervical plexus block combined with remifentanil and propofol conscious-sedation anesthesia for thyroid surgery

目的探讨颈丛麻醉下复合瑞芬太尼及丙泊酚清醒镇静麻醉用于甲状腺手术的临床应用。方法择期行甲状腺手术患者40例,其中男18例,女22例;年龄30～55岁;体质量50～80kg;ASAⅠ级。随机分为2组各20例。Ⅰ组(全麻组)常规全麻诱导后气管插管,术中维持全凭静脉瑞芬太尼及丙泊酚,分别以0.25～2、100～200μg·kg-1·min-1行恒速输注。Ⅱ组(颈丛复合瑞芬太尼及丙泊酚清醒镇静组)行单侧颈深丛及双侧颈浅丛神经阻滞后持续静脉泵注瑞芬太尼及丙泊酚,剂量分别为0.05～0.1μg·kg-1·min-1和1mg·kg-1·h-1,保持患者清醒镇静且手术无痛。记录麻醉前即刻(T0)、气管插管/颈丛阻滞后(T1)、手术前即刻(T2)、分离甲状腺期(T3)及气管导管拔出时(T4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)及脑电双频谱指数(BIS)值。记录术后4h视觉模拟评分(VAS评分)及舒适评分(BCS评分)。结果 2组患者SpO2差异无统计学意义(P>0.05);与Ⅰ组相比,Ⅱ组MAP在T1、T4期较平稳(P均<0.05),T0、T2、T3期2组MAP比较差异无统计学意义(P均>0.05);与Ⅰ组相比,Ⅱ组HR各时点均较平稳(P均<0.05),BIS值各时点均较高(P均<0.05)。术后4hVAS评分Ⅰ组略高于Ⅱ组,BCS评分Ⅰ组略低于Ⅱ组,但差异均无统计学意义(P均>0.05)。结论颈丛麻醉下复合瑞芬太尼及丙泊酚清醒镇静麻醉用于甲状腺手术方法简便,效果满意,不良反应少,是一种较理想的麻醉方法。

Objective To investigate the clinical effect of cervical plexus block combined with remifentanil and propofol conscious-sedation anesthesia for thyroid surgery. Methods Forty patients performed elective thyroid operation （18 males and 22 females, age 30-55 years old, body weight 50-80 kg, ASA Ⅰ ） were randomly divided into two groups （n =20 each） according to anesthesia method：general anesthesia group （group Ⅰ） and cervical plexus block combined with remifentanil and propofol conscions-sedation anesthesia group （group Ⅱ ）. In groupⅠ,following conventional tracheal incuba- tion after induction of anesthesia, constant intravenous infusing remifentanit （0. 25-2 μg·kg^-1 · min ^-1 ） and propofol （ 100- 200 μg· kg6-1· min ^-1 ） was applied to maintain anesthesia. In group Ⅱ , after unilateral deep cervical plexus and bilateral superficial cervical plexus block,continuous pump-infusion of remifentanil （0.05-0. 1 μg·kg^-1·min^-1 ） and propofol （ 1 mg·kg^-1·h^-1 ） was applied to keep the patient conscious-sedation state without pain. The values of the mean arterial pressure （ MAP）, heart rate （HR） ,pulse oxygen saturation （SpO2） and the bispeetral index （BIS） were recorded at five time points respectively： immediately before anesthesia （ To）, endotracbeal incubation/after cervical plexus block （ T1 ） ,immediately before operation（T2 ）, at the phase of separating thyroid （T3 ） and when pul- ling out the endotracheal tube （ T4 ）. Moreover, the visual an- alogue scale （VAS score） and comfort score （BCS ratings） four hours after operation were also recorded. ResultsThere were no significant difference in SpO2 between the two groups （P 〉0. 05）. Compared with the group Ⅰ ,MAP at Ⅱ ,T4 period in group Ⅱ was relatively stable （ all P 〈 0. 05 ）, while had not significant difference at TO, T2, T3 period （ all P 〉 0. 05 ）. Compared with group Ⅰ , the HRs at all time points in group Ⅱ were smoother （ all P 〈 0. 05 ）, and the BIS values at all time points in group Ⅱ were higher （ all P 〈 0. 05）. Compared with group Ⅱ, group Ⅰ had slightly higher VAS score and slightly lower BCS score four hours after operation, but there was no significant difference in two groups （ all P 〉 0. 05 ）. Condusimm The anesthesia method of cervical plexus block combined with remifentanil and propofol conscious-sedation anesthesia for thyroid operation has the advantages of simple procedure, satisfactory results, lower adverse reactions, and therefore is an ideal anesthesia method.