全身麻醉或联合颈丛阻滞用于甲状腺手术术后镇痛效果的观察

Comparison of analgesic efficacy between general anesthesia or general anesthesia combined with cervical plexus block administered in thyroid operation

目的比较术中单纯全身麻醉(以下简称全麻)与全麻联合颈丛阻滞两种麻醉方式对甲状腺手术患者术后疼痛及恶心、呕吐等相关合并症的发生率的影响。方法选择80例择期甲状腺手术患者为研究对象,按照基本特征组间均衡可比的原则分为全麻芬太尼组(Ⅰa组)、全麻舒芬太尼组(Ⅰb组)、全麻芬太尼+颈丛阻滞组(Ⅱa组)、全麻舒芬太尼+颈丛阻滞组(Ⅱb组),每组20例。比较各组患者术后疼痛情况视觉模拟(visual analogue scale,VAS)评分、拔管时间、苏醒质量及术后恶心呕吐发生率。结果术后2、6 h VAS评分组间比较差异有统计学意义(P<0.05),两两比较结果显示Ib、IIb组明显低于Ia、IIa组(P<0.05),但Ia组与IIa组间比较、Ib组与IIb组间差异无统计学意义(P>0.05)。术后24 h 4组间VAS评分差异无统计学意义(P>0.05)。各组间拔管时间、苏醒质量、术后24 h恶心呕吐发生率比较,差异均无统计学意义(P>0.05)。结论甲状腺手术单纯全麻和全麻联合颈丛阻滞两种麻醉方式对该类患者术后镇痛效果无明显差别,但选用舒芬太尼作为全麻镇痛组分较芬太尼能明显减轻甲状腺手术患者的术后VAS评分。

Objective To compare the analgesic efficacy and the incidence of the nausea and vomiting between general anesthesia(GA)and general anesthesia combined with cervical plexus block undergoing thyroid surgery.Methods A total of 80 patients who underwent elective thyroid operations were selected and assigned to four groups:GA fentanyl(groupⅠa,n=20),GA sufentanil(groupⅠb;n=20),GA fentanyl+cervical plexus block(groupⅡa,n=20),GA sufentanil+cervical plexus block(groupⅡb,n=20).Postoperative visual analogue scale(VAS)score,extubation time,recovery time and the incidence of postoperative nausea and vomiting(PONV)were recorded and compared in four groups.Results VAS scores showed significant difference between 2 and 6 h after operation(P<0.05);with that inⅠb andⅡb groups significantly lower than that inⅠa andⅡa(P<0.05).There was no significant difference between VAS scores inⅠa andⅡa,Ⅰb andⅡb groups(P>0.05).No difference was found in VAS score among four groups at 24 h after operation(P>0.05).There were no significant differences about the time of extubation and recovery(P>0.05).No difference of the incidence on PONV was observed among the four groups at the first 24 h postoperatively.Conclusion There was no significant difference between general anesthesia alone and general anesthesia combined with cervical plexus block.Compared with fentanyl sufentanil,sufentanil as a general anesthesia analgesic component could significantly reduce the VAS score of patients after thyroid surgery.