两种不同超前镇痛方式在甲状腺手术中的应用比较

Comparison of the application of two kinds of preemptive analgesia in thyroid operation

目的：探讨静脉注射一定剂量咪达唑仑与双侧颈浅丛罗哌卡因区域阻滞两种不同超前镇痛方式在甲状腺手术中的应用。方法选择全身麻醉下行甲状腺手术的患者60例，随机分为三组，每组20例。A 组在麻醉后切皮前10 min，以0.25%的罗哌卡因双侧颈浅丛神经阻滞麻醉，每侧注射5 ml；B 组在麻醉后切皮前10 min，静脉推注0.5 mg/ kg咪达唑仑注射液；C 组患者不做处理。三组术后4 h 内均不予任何镇痛处理，4 h 后根据患者要求，给予一定量的杜冷丁。所有病例均不予镇痛泵持续镇痛处理。分别观察并记录术中生命体征变化、术后并发症情况；记录术后1、2、3、4 h 患者安静时的疼痛视觉模拟评分（VAS），术后首次使用镇痛药时间、使用镇痛药的用量等。结果术后观察的各时间点，A 组、B 组 VAS 评分均小于 C 组，差异有统计学意义（P 〈0.05）；其中第4小时VAS 评分，A 组〈 B 组〈 C 组，差异有统计学意义（P 〈0.05）；术后首次使用镇痛药时间 A 组〉 B 组〉 C 组，差异有统计学意义（P 〈0.05）；镇痛药用量 A 组〈 B 组〈 C 组，差异有统计学意义（P 〈0.05）。结论在甲状腺手术中，术前应用双侧颈浅丛罗哌卡因区域阻滞或静脉注射一定剂量咪达唑仑，患者术后均能获得良好的镇痛效果，并降低患者额外镇痛药量，延长术后镇痛药使用时间，提高患者术后满意度。而术前双侧颈浅丛罗哌卡因区域阻滞较静脉注射咪达唑仑，降低患者使用额外镇痛药量更多，延长术后镇痛药使用时间更长。

Objective To study the effects of low dose midazolam intravenous and bilateral superficial cervical plex-us block in two different ways on thyroid operation preemptive analgesia effect. Methods Sixty patients with general anesthe-sia in thyroid operation were randomly divided into three groups,with 20 patients in each group. Group A：at 10 min before skin incision,injected 0. 25% ropivacaine through the bilateral superficial cervical plexus for block anesthesia,each side 5 ml;Group B：at 10 min before skin incision,carried out intravenous injection of 0. 5 mg/ kg midazolam;Group C：conduct no treatment. Three groups were not given any analgesic treatment in 4 h after operation,and a certain dose of dolantin was provided according to their requirements. All patients were not treated with PCA analgesia. The intraoperative vital signs, postoperative complications,Visual Analogue scale（VAS）after 1,2,3,4 h when patients were at rest,the first time for the use of postoperative analgesic,and analgesic use dosage were all observed and recorded. Results At each observation time point after operation,VAS in group A and group B were lower than that of in group C,and the differences were significant （P 〈 0. 05）;The 4 h VAS in group A 〈 group B 〈 group C,and the differences were statistically significant（P 〈0. 05）;the first analgesic time after the operation in group A 〉 group B 〉 group C,and the differences were significant（P 〈0. 05）;An-algesic dosage in group A 〈 group B 〈 group C,and the differences were significant（P 〈 0. 05）. Conclusions In thyroid operation,preoperative bilateral superficial cervical plexus block with ropivacaine or intravenous midazolam can bring patients good analgesic effect,reduce the use of additional analgesic,prolong the time of postoperative analgesic use,improve pa-tients’satisfaction. But the preoperative bilateral superficial cervical plexus block with ropivacaine can reduce the analgesic dosage and prolong analgesia in a bigger extend compared with intravenous midazolam.