右美托咪定用于甲状腺切除术针药复合麻醉中的效果研究

Effect of dexmedetomidine on combined acupuncture and drug anesthesia for thyroidectomy

目的探讨右美托咪定用于甲状腺切除术针药复合麻醉中的效果。方法回顾性分析2018年10月至2020年1月于中国人民解放军联勤保障部队第九六〇医院行甲状腺切除术的90例患者的临床资料。根据不同用药方法将其分成A组和B组,各45例。2组患者均给予针药复合麻醉,在此基础上,B组术前10 min予右美托咪定静脉泵注,A组术前10 min予同等剂量0.9%氯化钠注射液静脉泵注。比较2组患者舒芬太尼用药情况(术中追加次数、总药量)、术中血压与心率变化、术后疼痛程度、术后镇静程度以及不良反应(恶心、呕吐、频繁吞咽)发生情况。结果B组舒芬太尼术中追加次数、总药量均少于A组[(1.2±0.5)次比(2.1±0.7)次、(27±6)μg比(34±7)μg](均P<0.001);B组针刺诱导时、切皮时、分离皮瓣时、牵拉甲状腺时、缝皮时的收缩压、舒张压、心率均低于A组,差异均有统计学意义(均P<0.05)。B组术后6、12、24、48 h疼痛视觉模拟量表评分均低于A组,Ramsay镇静评分均高于A组,差异均有统计学意义(均P<0.001)。B组的不良反应发生率低于A组[13.3%(6/45)比31.1%(14/45)](P=0.043)。结论右美托咪定用于甲状腺切除术针药复合麻醉中的效果满意,可减少舒芬太尼使用量,稳定术中血压与心率,加强术后镇痛镇静效果,麻醉的有效性与安全性高。

Objective To investigate the effect of dexmedetomidine on combined acupuncture and drug anesthesia for thyroidectomy.Methods Clinical data of 90 patients undergoing thyroidectomy in the 960 th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from October 2018 to January 2020 were retrospectively analyzed.According to different medication methods,patients were divided into group A and group B,with 45 cases in each group.Patients in both groups were given combined acupuncture and drug anesthesia.On this basis,group B was given dexmedetomidine intravenous pumping at 10 min before operation,and group A was given equal volume of 0.9%sodium chloride injection intravenous pumping.The sufentanil medication(additional intraoperative times and total dosage),intraoperative blood pressure and heart rate changes,postoperative pain degree,postoperative sedation degree,and adverse reactions(nausea,vomiting,frequent swallowing)were compared between the two groups.Results The additional intraoperative times and total dosage of sufentanil in group B were less than those in group A[(1.2±0.5)times vs(2.1±0.7)times,(27±6)μg vs(34±7)μg](both P<0.001);systolic blood pressure,diastolic blood pressure and heart rate in group B during acupuncture induction,skin incision,skin flap separation,thyroid traction and skin suture were lower than those in group A(all P<0.05).Pain visual analogue scale scores at 6,12,24 and 48 h after operation in group B were lower than those in group A,and Ramsay sedation scores at 6,12,24 and 48 h after operation in group B were higher than those in group A(all P<0.001).The incidence of adverse reactions in group B was lower than that in group A[13.3%(6/45)vs 31.1%(14/45)](P=0.043).Conclusions Dexmedetomidine in combined acupuncture and drug anesthesia for thyroidectomy has satisfactory effect.It can reduce the dosage of sufentanil,stablilize blood pressure and heart rate,and enhance postoperative analgesisa and sedation,with high effectiveness and safety of anesthesia.