右美托咪定注射液用于甲状腺结节患者胸骨上切口甲状腺切除术的临床研究

Clinical trial of dexmedetomidine injection for suprasternal incision thyroidectomy in patients with thyroid nodules

目的观察右美托咪定注射液复合颈浅神经丛阻滞麻醉用于甲状腺结节患者胸骨上切口甲状腺切除术的临床疗效及安全性。方法将96例甲状腺结节患者随机分为对照组和试验组,每组48例。2组患者均予以颈浅神经丛阻滞麻醉,试验组静脉给予右美托咪定1.0μg·kg^-1,对照组静脉给予0.9%NaCl 1.0μg·kg^-1,之后均给予0.5μg·kg^-1·h^-1维持,静脉微泵。比较2组患者不同时间的血流动力学指标:心率(HR)和舒张压(DBP),警觉/镇静评分(OAA/S),疼痛视觉模拟评分(VAS),以及药物不良反应的发生情况。结果试验组在颈丛神经阻滞时(T1)、切皮时(T2)、腺体分离时(T3)、缝合皮肤时(T4)的HR分别为(72.63±2.58),(68.31±3.08),(65.39±2.92)和(62.44±3.16)beat·min^-1,DBP分别为(82.09±8.31),(74.62±8.38),(70.55±9.04)和(69.91±9.03)mmHg,OAA/S评分分别为(3.22±1.03),(2.74±0.46),(2.85±0.36)和(2.55±0.31)分,VAS分别为(1.26±1.01),(1.53±1.17),(0.94±1.31)和(1.24±0.92)分;对照组T1~T4的HR分别为(97.44±3.46),(99.35±2.24),(96.13±2.57)和(92.18±3.42)beat·min^-1,DBP分别为(88.01±11.59),(89.24±11.56),(87.17±10.73)和(86.42±10.41)mmHg,OAA/S评分分别为(4.13±1.11),(4.04±0.76),(4.02±0.98)和(4.01±0.87)分,VAS分别为(1.98±0.89),(2.34±1.22),(2.67±1.36)和(2.53±1.26)分;2组患者上述指标在不同时间点比较,差异均有统计学意义(均P<0.05)。试验组和对照组的总药物不良反应发生率分别为14.58%和22.92%,差异无统计学意义(P>0.05)。结论右美托咪定注射液复合颈浅神经丛阻滞麻醉用于甲状腺结节患者胸骨上切口甲状腺切除术的麻醉效果显著,其有利于稳定术中血流动力学,且不增加药物不良反应的发生率。

Objective To observe the clinical efficacy and safety of dexmedetomidine injection combined with superficial cervical plexus block anesthesia for thyroidectomy through superior sternal incision in patients with thyroid nodules.Methods Ninety-six patients with thyroid nodules were randomly divided into controland treatment groups with 48 cases per group.Two groups were given superficial jugular plexus block anesthesia.The treatment group was given dexmedetomidine 1.0μg·kg^-1 intravenously,and the control group was given 0.9%NaCl 1.0μg·kg^-1 intravenously.After that,they were maintained at 0.5μg·kg-1·h^-1 with venous micropump.The hemodynamics indexes:heart rate(HR),diastolic blood pressure(DBP),alertness/sedation score(OAA/S),and pain visual analogue score(VAS)and adverse drug reactions were compared between the two groups at different times.Results At the time of superficial cervical plexus block anesthesia(T1),skin incision(T2),gland separation(T3)and skin suture(T4),HR of the treatment group were(72.63±2.58),(68.31±3.08),(65.39±2.92)and(62.44±3.16)beat·min-1;DBP were(82.09±8.31),(74.62±8.38),(70.55±9.04)and(69.91±9.03)mm Hg;OAA/S were(3.22±1.03),(2.74±0.46),(2.85±0.36)and(2.55±0.31)scores;the VAS were(1.26±1.01),(1.53±1.17),(0.94±1.31)and(1.24±0.92)scores.For the control group,HR were(97.44±3.46),(99.35±2.24),(96.13±2.57)and(92.18±3.42)beat·min-1;DBP were(88.01±11.59),(89.24±11.56),(87.17±10.73)and(86.42±10.41)mm Hg;OAA/S were(4.13±1.11),(4.04±0.76),(4.02±0.98),(4.01±0.87)scores;the VAS were(1.98±0.89),(2.34±1.22),(2.67±1.36),(2.53±1.26)scores from T1-T4.Compared with the indexes of the two groups at different times,the differences were statistically significant(all P<0.05).The incidence of adverse drug reactions was 14.58%in the treatment group and 22.92%in the control group respectively,without statistically significant difference(P>0.05).Conclusion The anesthesia effect of dexmedetomidine injection combined with superficial cervical plexus block anesthesiaon thyroidectomy of suprasternal incision in patients with thyroid nodule is significant,it is conducive to stabilize intraoperative hemodynamics,without increasing the incidence of adverse drug reactions.