小剂量瑞芬太尼辅助颈从阻滞麻醉下甲状腺手术的临床观察

Clinical Observation of Small dose Remifentanil Assisted Cervical Anesthesia for Thyroidectomy

目的 分析并探讨小剂量瑞芬太尼用于辅助颈从阻滞麻醉下甲状腺手术中牵拉反应的效果和不良反应,并评价其临床价值。方法 本次研究选取2012年4月至2013年3月来我院就诊并为择期甲状腺手术患者50例,手术采用1%利多卡因＋0.45%罗哌卡因行双侧颈从麻醉后随机分为AB两组。A组为对照组,共有患者24例,采取静脉注射哌氟合剂2 m L,并根据手术情况及患者反应适当增加1/3∽1/2;B组为实验组,采取微泵静脉推注瑞芬太尼0.5μg/kg,持续3 min,随后采取0.05μg/（kg·min）注射。手术过程中详细观察BP、HR的变化以及患者的镇静情况,术后用VAS评分来说明术中牵拉的疼痛程度。结果 与对照组相比,实验组织术中的BP、HR明显较为稳定（P〈0.05）,且术后经过VAS评分也表明实验组的疼痛程度远远低于对照组。结论 小剂量的瑞芬太尼对于辅助颈从阻滞麻醉下甲状腺手术的临床疗效显著,值得临床进一步推广和使用。

Objective To analysis and small dose of fentanyl used for auxiliary of rayleigh neck from block anesthesia of thyroid surgery pull effect and adverse reaction of the reaction, and evaluate its clinical value. Methods This study selected in April 2012 to March 2013 to our hospital and provide names of 50 patients with thyroid surgery, surgery with 1% lidocaine ＋ 0.45% ROM pp line because after bilateral neck from anesthesia were randomly divided into AB two groups： group A as the control group, with A total of 24 patients with, take intravenous pp fluorine agent 2 mL, and according to the operation conditions and reaction in patients with appropriate increase 1/3 to 1/2.As experimental group B, adopts the micro pump intravenous push rick fentanyl injection 0.5 gg/kg, for 3 min, then take 0.05/ag/（kgomin） injection. Then observe the changes of BP and HR in detail in the process of surgery and the patient＇s calm, after using VAS score to illustrate the pain degree of intraoperative pull. Results Compared with control group, experimental group of BP and HR markedly more stable （P〈0.05）, and postoperative after the pain VAS scores also showed that the experimental group is much lower than the control group. Conclusion Small dose of fentanyl for auxiliary neck from block anesthesia of thyroid surgery clinical curative effect is distinct, worthy of further promotion and clinical use.