不同镇痛方式对甲状腺术后疼痛的影响

Efficacies of different analgesic methods in thyroidectomy

目的:观察地佐辛静脉注射与左旋布比卡因+利多卡因行浅颈丛注射两种方法用于甲状腺术后镇痛效果的比较。方法:全麻下行甲状腺切除术患者60例,随机分为3组:对照组(C组)在全麻诱导即刻给予静脉注射生理盐水5 m L;地佐辛组(D组)在全麻诱导后即刻静脉注射地佐辛10 mg;颈丛阻滞组(B组)在全麻诱导前行双侧颈浅丛阻滞,每侧各6 m L(局麻药为0.375%左旋布比卡因+1%利多卡因合剂)。分别观察3组患者术后4、8、12、24 h的切口疼痛、咽痛以及恶心呕吐发生率。结果:B组和D组的患者VAS评分比较差异无统计学意义,在术后12 h以内各时点的镇痛评分均小于C组,差异有统计学意义。3组患者用药后的不良反应差异无统计学意义。结论:术前静脉注射地佐辛注射液或者行颈浅丛神经阻滞注射利多卡因与左旋布比卡因混合液均可为甲状腺切除手术术后12 h内提供良好的术后镇痛,且不增加不良反应的发生率。

Objective： To compare the analgesic efficacies of intravenous injection of dezocine and bupivacaine plus lidocanie in bilateral superficial cervical plexus block（ BSCPB） following thyroid surgery.Methods： Sixty patients undergoing thyroidectomy were randomized into control group（ group C,n = 20,intravenous injection of normal saline in dose of 5 m L）,dezocine group（ group D,n = 20,intravenous dezocine in dose of 10 mg following induction of general anesthesia）,and BSCPB group（ group B,n = 20,1% lidocaine ＋ 0.375% levobupivacaine,lateral dose of 6m L before general anesthesia induction）.Visual analogue scale（ VAS） was used to assess the analgesic effects in the 4 th,8 th,12 th and 24 th hour after surgery. Incidence of incision pain,sore throat,nausea,vomiting and dizzy were observed coinstantaneous in the three groups. Results： There was no significant differences between group B and group D on VAS scoring（ P〉0.05）,yet the two groups had lower VAS scoring than group C within 12 hours after surgery（ P〈0.05）. The three groups remained no significant difference in incidences of nausea and vomiting（ P〉0.05）. Conclusion： Either preoperative intravenous injection of dezocine or BSCPB with lidocaine plus levobupivacaine can lead to satisfactory postoperative analgesia within 12 hours following thyroidectomy,and will not augment incidence of adverse reactions.