甲状腺手术中不同全身麻醉方法的费用-效果分析

Cost-effectiveness analysis of different general anesthesia methods in thyroid surgery

目的对甲状腺手术中应用的3种麻醉方法进行费用-效果分析。方法前瞻性收集上海市黄浦区东南医院2018年1-6月行甲状腺手术的患者260例,随机分为丙泊酚组(87例,采用丙泊酚全凭静脉麻醉)、丙泊酚地氟烷组(82例,采用静吸复合全身麻醉、丙泊酚诱导麻醉、地氟烷吸入维持麻醉)和颈浅丛阻滞丙泊酚地氟烷组(91例,采用静吸复合全身麻醉联合颈浅丛神经阻滞、丙泊酚诱导麻醉、地氟烷吸入维持麻醉)。记录患者术中生命体征,以及体动和呛咳等不良反应的发生情况,麻醉时间、手术时间、气管插管时间、自主呼吸恢复时间、苏醒时间、拔除气管导管时间、定向力恢复时间,术后恶心呕吐(PONV)等麻醉不良反应发生情况和疼痛VAS评分,麻醉药物和相关药物、耗材费用、丙泊酚和(或)地氟烷费用、所有麻醉药物费用、PONV治疗药物费用、术后止痛治疗药物费用、麻醉总费用。结果 3组患者术中心动过缓、高血压、体动和呛咳等不良反应,以及苏醒期和术后第1天PONV发生率的差异均无统计学意义(P值均>0.05)。颈浅丛阻滞丙泊酚地氟烷组术中舒芬太尼用量显著少于丙泊酚组和丙泊酚地氟烷组(P值均<0.05),苏醒期和术后第1天的疼痛VAS评分显著低于丙泊酚组和丙泊酚地氟烷组(P值均<0.05)。丙泊酚组和颈浅丛阻滞丙泊酚地氟烷组的麻醉总费用均显著高于丙泊酚地氟烷组(P值均<0.05)。结论静吸复合全身麻醉联合罗哌卡因颈浅丛神经阻滞应用于甲状腺手术的效果最佳,可明显减少术中阿片类药物的使用量,减轻术后疼痛;而静吸复合全身麻醉的费用最少。

Objective To analyze the cost-effectiveness of three anesthetic techniques used in thyroid surgery. Methods A total of 260 patients undergoing thyroid surgery from January to June 2018 were selected prospectively. They were randomly divided into propofol group(n=87, total intravenous anesthesia with propofol), propofol desflurane group(n=82, inhalation combined with general anesthesia, propofol-induced anesthesia, desflurane inhalation to maintain anesthesia), and cervical superficial plexus block propofol desflurane group(n=91, inhalation+general anesthesia+cervical superficial plexus block, propofol-induced anesthesia, desflurane inhalation to maintain anesthesia).Vital sign, adverse reactions, including body movement and cough during the operation, anesthesia time, operation time, tracheal intubation time, autonomous respiration time, recovery time, tracheal catheter removal time, orientation recovery time, postoperative nausea and vomiting(PONV) and other anesthetic adverse reactions, visual analogue scale(VAS) scores, anesthetic and treatment costs, were recorded. Results There were no significant differences in the occurrence of intraoperative bradycardia, hypertension, body movement or cough, or the incidence of PONV during the recovery period and in the first day after surgery between groups(all P>0.05). The consumption of sufentanil and VAS during the recovery period and in the first day after surgery in the cervical superficial plexus block propofol desflurane group were significantly lower than those in the other two groups(all P<0.05). The total anesthesia cost of the propofol desflurane group was significantly less than that of the other two groups(both P<0.05). Conclusion Of the three anesthetic techniques, intravenous inhalation plus general anesthesia combined with ropivacaine for cervical superficial plexus block can achieve the best anesthetic effect for thyroid surgery, significantly reducing the use of intraoperative opioids and postoperative pain, and intravenous inhalation combined with general anesthesia has the least costs.