超声引导下颈神经通路阻滞在甲状腺手术术中及术后早期镇痛中的应用

Application of ultrasound guided cervical nerve pathway blocking in intraoperative and postoperative early analgesia of thyroid surgery

目的探讨超声引导下颈神经通路阻滞对行甲状腺手术患者的镇痛效果。方法选择2013年1月至2016年4月择期行甲状腺手术患者106例,采用随机数字表及随机余数分组法将患者分为观察组和对照组,每组63例。观察组在超声引导下颈神经通路阻滞,对照组超声引导下颈浅丛阻滞,比较2组麻醉效果、手术一般情况、麻醉期间血压及心率、疼痛情况及不良反应发生率。结果观察组与对照组比较:麻醉优良率(均为100%)、麻醉达成时间、手术时间、拔管时间、在恢复室停留时间、各时间点血压及心率、T2时间点VAS评分、术后24 h及术后48 h运动状态下VAS评分、麻醉相关不良反应发生率(4.76%VS 3.17%)等指标,组间比较差异均无统计学意义(P>0.05);T3时VAS评分[(3.15±0.46)VS(4.01±0.53)]分、术后1 h运动状态下VAS评分[(2.06±0.34)VS(2.98±0.37)]、术后8 h运动状态下VAS评分[(1.67±0.22)VS(2.41±0.31)],组间比较差异有统计学意义(P<0.05)。结论超声引导下颈神经通路阻滞与颈浅丛阻滞麻醉效果相当,颈神经通路阻滞术中及术后镇痛效果更理想。

Objective To observe the analgesia effects of ultrasound guided cervical nerve pathway blocking on patients receiving thyroid surgery. Methods One hundred and six patients who underwent thyroid surgery in our hospital from January 2013 to April 2016 were divided into observation group（ n = 63） and control group（ n = 63） according to random number table. The patients in observation group received ultrasound guided cervical nerve pathway blocking,however,the patients in control group received ultrasound guided superficial cervical plexus blocking. The anesthesia effect,general situation of operation,blood pressure and heart rate during anesthesia,pain and the incidence rate of adverse reactions were observed and compared between two groups. Results There were no significant differences in the good rate of anesthesia（ both100%）,anesthesia complete time,surgical time,extubation time,length of staying in recovery room,blood pressure and heart rate in different time points,VAS score in T2,VAS scores on 24 h and 48 h after operation in movement condition,anesthesia-related incidence rate of adverse reactions（ 4. 76% vs 3. 17%） between observation group and control group（ P 0. 05）.However there were significant differences in VAS score in T3（ 3. 15 ± 0. 46 vs 4. 01 ± 0. 53）,VAS score on 1h aftr operation in movement condition（ 2. 06 ± 0. 34 vs 2. 98 ± 0. 37）,VAS score on 8h aftr operation in movement condition（ 1. 67 ± 0. 22 vs 2. 41 ± 0. 31） between observation group and control group（ P 0. 05）. Conclusion The analgesia effects of ultrasound guided cervical nerve pathway blocking on patients receiving thyroid surgery are similar to those of ultrasound guided superficial cervical plexus blocking,but the intraoperative and postoperative analgesia effects of ultrasound guided cervical nerve pathway blocking are more satisfactory.