颈丛神经阻滞联合全身麻醉下老年甲状腺癌根除术的效果观察

Efficacy of radical thyroidectomy with cervical plexus nerve block combined with general anesthesia in elderly patients with thyroid cancer

目的探讨颈丛神经阻滞联合全身麻醉在老年甲状腺癌根除术中的应用效果。方法选取2016年2月至2020年11月间西安市人民医院行甲状腺癌根除术的72例老年患者进行研究,采用随机数表法将患者分为对照组和观察组,每组36例。对照组采用全身麻醉下实施甲状腺癌根除术,观察组采用颈丛神经阻滞联合全身麻醉下甲状腺癌根除术。比较两组患者麻醉前和术毕的激素水平、血流动力学水平及血糖水平,比较两组患者麻醉苏醒质量。结果麻醉前,两组肾上腺素、皮质醇和去甲肾上腺素水平比较,差异无统计学意义(P>0.05)。术毕,和麻醉前比较,两组肾上腺素、皮质醇和去甲肾上腺素水平均升高,但观察组患者升高程度低,差异均有统计学意义(均P<0.05)。麻醉前,两组平均动脉压(MAP)、心率(HR)和血糖水平比较,差异无统计学意义(P>0.05);术毕,两组MAP、血糖水平均升高,观察组升高程度低,差异均有统计学意义(均P<0.05)。两组患者恢复自主呼吸时间、睁眼时间和拔管时间比较,差异无统计学意义(P>0.05)。结论颈丛神经阻滞联合全身麻醉下老年甲状腺癌根除术,可减轻患者激素和血糖水平升高程度,维持血流动力学稳定,并不会对患者麻醉苏醒质量造成影响。

Objective To explore the efficacy of cervical plexus nerve block combined with general anesthesia in elderly patients with thyroid cancer undergoing radical thyroidectomy.Methods Seventy-two elderly patients undergoing radical thyroidectomy for thyroid cancer were selected at Xi’an People’s Hospital between February 2016 and November 2020.The patients were divided into an observation group and a control group with 36 patients in each group.The observation group underwent radical thyroidectomy with cervical plexus nerve block combined with general anesthesia and the control group underwent radical thyroidectomy with general anesthesia.The hormone,hemodynamic and blood glucose levels before and after the anesthesia and the quality of awakening from anesthesia were compared between the two groups.Results Before anesthesia,there was no significant difference in the levels of epinephrine,cortisol and norepinephrine between the two groups(P>0.05).After the operation,the levels of epinephrine,cortisol and norepinephrine increased in the two groups compared with those before the anesthesia,but the degree of elevation was lower in the observation group than in the control group(all P<0.05).Before anesthesia,there was no difference in mean arterial pressure(MAP),heart rate(HR),and blood glucose levels between the two groups(P>0.05).After the operation,MAP and blood glucose levels increased in the two groups compared with those before anesthesia,but the increase was lower in the observation group than in the control group(all P<0.05).There was no difference in the time to spontaneous breathing,time to eye-opening and time to extubation between the two groups(P>0.05).Conclusion Cervical plexus block combined with general anesthesia can reduce the increase in hormones and blood sugar levels,maintain hemodynamic stability,and will not affect the quality of awakening from anesthesia in elderly patients with thyroid cancer undergoing radical thyroidectomy.