右美托咪定复合小剂量氯胺酮用于颈丛麻醉下甲状腺手术临床观察

Supplemental anesthesia with dexmedetomidine and low-dose ketamine for thyroidectomy patients under cervical plexus block anesthesia

目的：观察右美托咪定复合小剂量氯胺酮对颈丛麻醉下甲状腺手术患者施以辅助麻醉的临床效果。方法：选择ASAⅠ-Ⅲ级颈丛麻醉下甲状腺手术患者70例,随机双盲分为2组,于颈丛麻醉后手术切皮前5min,Ⅰ组（40例）静脉泵注右美托咪定0.8μg/（kg·h）、静脉注射氯胺酮0.8mg/kg;Ⅱ组（30例）静脉注射氟哌利多0.06mg/kg＋芬太尼1.2μg/kg。观察对比两组患者术中镇静镇痛效果。结果：两组病例一般资料、手术时间、手术范围等无统计学差异;术中生命体征监测数据Ⅰ组较Ⅱ组平稳,但无统计学意义（P〉0.05）;术中镇痛评分（NRS）Ⅰ组低于Ⅱ组（P〈0.05）,Ⅰ组镇痛效果较好;镇静评分（RSS）两组无显著差异（P〉0.05）,镇静效果均较满意。结论：右美托咪定复合小剂量氯胺酮用于颈丛麻醉下的甲状腺手术,其辅助麻醉效果良好。

Objective： To observe the clinical effect of basal anesthesia with dexmedetomidine and low- dose ketamine on thyroidectomy during block anesthesia of the cervical nerve. Methods. Seventy patients underwent thyroidectomy under cervical plexus block anesthesia （ASA Ⅰ - Ⅲ ） were randomly divided into two groups： observation group （n=40） intravenously injected dexmedetomidine （0.8μg/kg · h） by pump and ketamine 0. 8mg/kg after cervical plexus block and 5 minutes before surgery, and control group （n= 30） intravenously received droperidol （0.06mg/kg） and fentanyl （1.2μg/kg）. The intraoperative sedation （RSS） and analgesia （NRS） effects were evaluated with Ramsay sedation score （RSS） and numeric rating scale （NRS） and compared between two groups. Results, There were no statistical differences in general data, intraoperative vital signs, operative time and techniques between two groups （P〉0. 05）. The intraoperative NRS in observation group was lower than that in control group （P〈0.05）, indicating that the better analgesia effect was found in observation group. There was no significant difference in intraoperative RSS between two groups （P〉0. 05） , with satisfactory sedation effect in both groups. Conclusion. The supplemental anesthesia with dexmedetomidine and low-dose ketamine has satisfactory effect for patients undergoing thyroidectomy under cervical plexus block anesthesia.