颈浅丛神经阻滞辅以靶控输注丙泊酚-瑞芬太尼麻醉用于双侧甲状腺手术

The application of superficial cervical plexus nerve block supplemented with target control infusion of propofol and remifentanyl anesthesia in thyroid operation

目的:探讨颈浅丛神经阻滞辅以靶控输注丙泊酚-瑞芬太尼麻醉用于双侧甲状腺手术中的有效性、安全性。方法:将80例ASAⅠ～Ⅱ级甲状腺腺瘤或结节性甲状腺肿行双侧甲状腺切除术的患者随机分为颈浅丛神经阻滞辅以丙泊酚-瑞芬太尼靶控输注组(Ⅰ组)和对照组(Ⅱ组),每组40例,两组都行双侧颈浅丛神经阻滞。Ⅰ组:丙泊酚血浆靶浓度0.8μg/mL,瑞芬太尼0.8 ng/mL同时输注,待患者进入镇静分级评分(Ramsay)2级时开始手术,缝合皮肤时停止给药。Ⅱ组:于手术前静脉给与芬太尼2μg/kg。观察两组病人术前、手术开始、分离甲状腺、术毕平均动脉压、心率变化、Ramsay评分及镇痛评分。结果:Ramsay评分:Ⅰ组在分离甲状腺时与术前相比有显著性差异,Ⅱ组与术前相比各时段均有差异,Ⅰ组和Ⅱ组之间在手术开始和分离甲状腺时也有差异(P<0.05)。镇痛评分:Ⅰ组与术前相比各时段无显著性差异,Ⅱ组与术前相比各时段均有差异,Ⅰ组和Ⅱ组之间在手术开始、分离甲状腺和术后均有差异(P<0.05)。手术过程中平均动脉压、心率Ⅱ组明显上升(P<0.05)。结论:颈浅丛神经阻滞辅以靶控输注丙泊酚-瑞芬太尼麻醉用于双侧甲状腺手术镇静和镇痛麻醉效果满意,血流动力学稳定,是一种可行的麻醉方法。

Objective： To investigate the efficacy of the superficial cervical plexus nerve block supplemented with target control infusion（TCI） of propofol and remifentanyl anesthesia in thyroid operation.Methods： 80 patients accepting thyreoidectomy were divided into two groups,groupⅠ（TCI） and groupⅡ（control group）.Each group were 40 cases and everyone accepted superficial cervical plexus nerve block anesthesia.In group Ⅰ propofol and remifentanyl blood plasma target level were 0.8 μg/mL and 0.8 ng/mL respectively.When Ramsay score was 2,the operation started and at the end of operation propofol-remifentanyl stoped.In groupⅡ before the operation,fentanyl 2 μg/kg was injected iv.Then the changes of mean arterial blood pressure（MAP） and heart rate（HR） were recorded before operation,starting operation,dissociating thyroid,and ending operation.Results： In group Ⅰ when dissociating thyroid,the number of patients at Ramsay score 2 were obvious less than before operation.But there were obvious changes of analgesia score 1 during every time points in groupⅡ.There were obvious changes during starting operation and dissociating thyroid between two group（P0.05）.In groupⅠthere were no changes during every point,but it had obvious change during every point in groupⅡ.It had obvious change during every periods between two group（P0.05）.And the increases of MAP and HR were obviously in groupⅡ.Conclusion： The article indicates using this type compound anestheais,the hemodynamics are stable,analgesia and sedation clinical effects are satisfactory.