不同辅助用药对甲状腺手术颈丛神经阻滞麻醉效果的影响

Influence of Different Auxiliary Drugs on Effect of Block Anesthesia of Cervical Plexus in Thyroid Surgery

目的观察不同辅助用药对甲状腺手术颈丛神经阻滞麻醉效果的影响。方法选择我院择期于颈丛神经阻滞麻醉下行甲状腺腺瘤切除手术120例,随机将其分为4组,每组30例。芬太尼组辅助使用芬太尼2μg/kg,右美托咪定组辅助使用右美托咪啶1μg/kg,咪达唑仑组辅助使用咪达唑仑0.05 mg/kg,芬太尼加咪达唑仑组辅助使用芬太尼2μg/kg、咪达唑仑0.05 mg/kg。观察比较4组入室后、用药前后平均动脉压(MBP)、脉搏氧饱和度(SpO2)、心率(HR),用药前后镇静-躁动评分及躁动、镇静过深、血管活性药物使用情况。结果①MBP、SpO2、HR情况比较:用药后5 min,4组MAP、HR、SpO2均有所下降,其中MAP、HR右美托咪啶组与其他各组同一时间点及组内给药前比较差异均有统计学意义(P<0.001);SpO2右美托咪啶组、咪达唑仑组及芬太尼加咪达唑仑组与用药前比较差异均有统计学意义(P<0.05或P<0.001),咪达唑仑组、芬太尼加咪达唑仑组与芬太尼组、右美托咪啶组比较均下降明显,差异有统计学意义(P<0.05或P<0.001)。②麻醉效果比较:镇静-躁动评分用药后5 min咪达唑仑组、芬太尼加咪达唑仑组均较芬太尼组、右美托咪啶组明显降低,差异均有统计学意义(P<0.05);用药后15 min、30 min咪达唑仑组、芬太尼加咪达唑仑组均较芬太尼组、右美托咪啶组明显升高,差异均有统计学意义(P<0.05);芬太尼加咪达唑仑组较咪达唑仑组降低,差异亦均有统计学意义(P<0.05)。出现躁动率芬太尼加咪达唑仑组低于咪达唑仑组,两组比较差异有统计学意义(P<0.05)。镇静过深率咪达唑仑组、芬太尼加咪达唑仑组均明显高于芬太尼组、右美托咪啶组,差异均具有统计学意义(P<0.05)。血管活性药物使用率右美托咪啶组明显低于其他3组,差异均具有统计学意义(P<0.001)。结论右美托咪啶具有清醒镇静作用,能够很好地阻断颈丛神经阻滞后交感神经兴奋作用,且血流动力学稳定,适宜作为甲状腺手术颈丛神经阻滞麻醉辅助用药。

Objective To observe the effect of different auxiliary drugs on effect of block anesthesia of cervical plexus in thyroid surgery. Methods A total of 120 patients, who would undergo selective operation of thyroid surgery under block anesthesia of cervical plexus, were divided into four groups （ n = 30）. Group A was treated with 2 p4/kg of auxiliary Fenta- nyl; group B was treated with 1 μg/kg of auxiliary Dexmedetomidine ; group C was treated with 0.05 mg/kg of auxiliary Mid- azolam ; group D was treated with 2 μg/kg of Fentanyl and 0.05 mg/kg of Midazolam. The indexes of mean arterial pressure （MBP） , pulse oxygen saturation （ SpO2 ） and heart rate （HR） after entering the operation room, before and after the medica- tion in the four groups were observed and compared, and sedation-agitation score （SAS） , excessive sedation and usage of va- soactive drugs before and after the medication were also analyzed. Results The levels of MBP, SpO2 and HR in the 4 groups were decreased 5 rain after the medication, and levels of MBP and HR in group B showed significant differences compared with those before the medication in the same group, and other groups at the same time （ P 〈 0. 001 ） ; the SpO2 level after the medi- cation in group B, C and D showed significant differences compared with that before the medication in the same group （P 〈 0. 05 or P 〈0. 001 ） , and SpO2 levels in group C and D were lower compared with those in group A and B, and the differences were statistically significant （P 〈 0.05 or P 〈 0. 001 ）. The SASs were significantly lower 5 min after the medication in groupC and D compared with those in group A and B, and the differences were statistically significant （ P 〈 0. 05 ） ; SASs were sig- nificantly higher 15 and 30 min after the medication in group C and D compared with those in group A and B, and the differ- ences were statistically significant （ P 〈 0.05 ） ; SAS in group D was significantly lower than that in group C （ P 〈 0.05 ）. Inci- dence rate of agitation in group D was lower than that in group C, and the difference was statistically significant （P 〈 0.05 ）. Incidence rates of excessive sedation in group C and D were higher than those in group A and B, and the differences were sta- tistically significant （P 〈 0.05 ）. The usage rate of vasoactive drugs in group B was significantly lower than those in group A, C and D, and the differenced were statistically significant （P 〈 0. 001 ）. Conclusion Dexmedetomidine has a good con- scious-sedation effect, and it may block sympathetic activation well after cervical plexus blocking with stable haemodynamics. Dexmedetomidine is suitable as the auxiliary drug in block anesthesia of cervical plexus in thyroid surgery.