过伸体位对甲状腺手术患者椎动脉供血的影响及其与术后患者恶心呕吐的相关性分析

Effects of Neck Hyperextension Position on Hemodynamics of Vertebral Artery Following Thyroidectomy and Correlation Between Change of Hemodynamics and Postoperative Nausea and Vomiting

目的探讨过伸体位对甲状腺手术患者术后椎动脉血流动力学的影响,并分析其变化与患者术后发生恶心呕吐的相关性。方法选取158例拟行甲状腺手术患者,分别测定术前6 h及术后6 h平卧位双侧椎动脉血流动力学指标(平均血流速度和平均血流量),并观察患者术后发生恶心呕吐的差异;同时选取同期89例行腹腔镜胆囊切除术(LC)患者并观察其术后恶心呕吐情况,并与甲状腺手术患者进行对比。2组手术的麻醉方式和用药相同。结果甲状腺手术患者术后双侧椎动脉平均血流速度较术前明显降低(P<0.05),平均血流量较术前明显减少(P<0.05);发生0次、2次、3次、4次恶心呕吐患者甲状腺手术组明显多于LC组(P<0.05,P<0.01),发生恶心呕吐的持续时间(1次、2次、3次、4次)甲状腺手术组亦明显长于LC组(P<0.01)。恶心呕吐的发生与甲状腺患者双侧椎动脉血流量的变化量及双侧血流速度变化量呈正相关(血流量变化量:rs=0.697,P=0.03;血流速度变化量:rs=0.897,P=0.01)。结论甲状腺手术过程中患者过伸体位对椎动脉血流动力学有一定的影响,同时对甲状腺手术患者术后发生恶心呕吐会有影响。

Objective To approach the effect of neck hyperextension position on hemodynamics of vertebral artery following thyroidectomy,and analyze the correlation between the change of hemodynamics and nausea and vomiting.Methods One hundred and fifty-eight patients with preparing for thyroidectomy（thyroidectomy group）and 89 patients with laparoscopic cholecystectomy（LC,LC group）were selected.The anesthesia method and the anesthesia drugs were the same in two groups.The indexes of hemodynamics of the bilateral vertebral artery at 6 h before and after thyroidectomy were measured.The difference of nausea and vomiting was observed and compared in two groups.Results The average blood flow velocity of the bilateral vertebral artery reduced and the blood flow decreased at 6 h after thyroidectomy as compared with at 6 h before thyroidectomy（P0.05）.The rates of nausea and vomiting of 0,2,3,4 times in the thyroidectomy group were significantly higher than those in the LC group（P 0.05,P 0.01）.The durations of nausea and vomiting of 1,2,3,4 times in the thyroidectomy group were also significantly longer than those in the LC group（P0.01）.There was a positive correlation between the nausea and vomiting and the changes of blood flow velocity or blood flow（change of blood flow velocity：rs=0.697,P=0.03;change of blood flow：rs=0.897,P=0.01）.Conclusions There is a certain effect of the neck hyperextension position on hemodynamics of the bilatreal vertebral artery,and which might affect the nausea and vomiting following thyroidectomy.