右美托咪定复合局麻药对颈丛阻滞效果的影响

Effect of Dexmedetomidine Compound Local Anesthetic on the Effect of Cervical Plexus Block

目的观察盐酸右美托咪定复合盐酸利多卡因、盐酸罗派卡因混合液用于双侧颈丛神经阻滞麻醉下行甲状腺手术的临床效果。方法选择2012年8月至2018年10月广东省汕头市第二人民医院收治的甲状腺手术患者149例,使用随机数字法分将患者分为试验组72例(局麻药含有1μg/kg盐酸右美托咪定),对照组77例(单纯使用局麻药)。治疗过程中试验组组有2例,对照组有5例患者术中出现血压升高,心率加快,无法配合手术,改行气管插管或置入喉罩行全身麻醉完成手术,予以剔除研究队列。二组均行一点法颈浅丛神经阻滞,观察记录麻醉前(T_(0))、双侧颈浅丛神经阻滞麻醉后5 min(T_(1))、切皮时(T_(2))、分离腺体时(T_(3))、切除腺体时(T_(4))、蓬合皮肤后(T_(5))平均动脉压(MAP),心率(HR)水平变化,术后患者的不良反应和满意度。结果试验组T_(1)时MAP,HR水平比较均低于T_(0)时,其中HR下降更为显著,部分患者下降幅度>20%(均在可允许的范围内,无需使用药物干预),差异有统计学意义(P<0.01);T_(3),T_(4)时MAP,HR水平回升,但与T_(0)时比较差异无统计学意义(P>0.05);T_(2),T_(5)时MAP,HR水平与T_(0)时比较差异有统计学意义(P<0.05)。对照组T_(1)、T_(5)与T_(0)时MAP,HR水平比较,均有所升高,但差异无统计学意义(P>0.05),T_(2)、T_(3)、T_(4)比T_(0)时MAP,HR水平明显升高,差异有统计学意义(P<0.05)。A,试验组间比较,T_(1),T_(2),T_(3),T_(4),T_(5)时MAP,HR水平比较,差异有统计学意义(P<0.01)。术后6 h随访,A,D两组的镇静评分差异无统计学意义。术后第1 d随访,A,D两组的镇静评分差异无统计学意义(P>0.05)。两组术后24 h不良反应(恶心、呕吐、头昏、眩晕)发生率与术后6 h比较,不良反应发生率均有所降低。但组间术后各时段不良不良反应发生率比较,差异无统计学意义(P>0.05)。术后6 h、术后24 h试验组切口疼痛发生率均低于对照组,差异有统计学意义(P<0.05)。术后6 h、术后24 h试验组满意率与对照组比较,差异无统计学意义(P>0.05)。结论盐酸右美托咪定复合局麻药用于颈丛阻滞下行甲状腺手术,患者血流动力学更稳定,术后患者满意度更高。

Objective To observe the clinical effect of dexmedetomidine hydrochloride compound lidocine hydrochloride and rodocaine hydrochloride mixture for thyroid surgery under anesthesia with bilateral cervical plexus block anesthesia.Methods A total of 149 thyroid surgery patients admitted to Shantou Second People's Hospital of Guangdong Province from August 2012 to October 2018 were divided into experimental group(72 patients,local anesthetic containing 1μg/kg dexmedetomidine hydrochloride)and control group(77 patients,local anesthetic alone)by random digital method.During the treatment,there were 2 patients in the trial group,and 5 patients in the control group had elevated blood pressure and accelerated heart rate,which could not cooperate with the operation,endotracheal intubation or laryngeal mask was inserted to complete the operation,so the research objects were excluded.One-point superficial cervical plexus block was performed in both groups.Changes of mean arterial pressure(MAP),heart rate(HR)levels at pre-anesthesia(T_(0)),5 min after anesthesia by bilateral superficial cervical plexus block(T_(1)),cutting the skin(T_(2)),during gland separating(T_(3)),during removal of glands(T_(4)),and after skin closure(T_(5)),adverse reactions and satisfaction of the patients after surgery were observed and recorded.Results In the experimental group,MAP and HR levels at T_(1)were lower than T_(0),and HR decreased more significantly,and some patients decreased by>20%(all within the allowable range,without drug intervention),and the difference was statistically significant(P<0.01);MAP and HR levels rebounded at T_(3),T_(4),however,there were no significant differences compared with those at T_(0)(P>0.05);MAP and HR levels at T_(2),T_(5)were significantly different when compared with T_(0)(P<0.05).In control group,MAP and HR levels at T_(1),T_(5)were increased than those at T_(0),but the differences were not significant(P>0.05);The MAP and HR levels at T_(2),T_(3),T_(4)increased significantly than those at T_(0)(P<0.05).Comparing between two groups,MAP and HR levels at T_(1),T_(2),T_(3),T_(4),and T_(5)were significantly different(P<0.01).There were no significant differences in sedation scores at 6 h and 1d after surgery between two groups(P>0.05).The incidence of adverse reactions(nausea,vomiting,dizziness,and vertigo)was reduced at 24 h compared with 6 h in both groups.However,the incidence of adverse effects at different period after surgery was not significantly different between two groups(P>0.05).The incidence of incision pain at 6 h and 24 h was lower than that of the control group,which was statistically significant(P<0.05).There was no significant difference in the satisfaction rate at 6 h and 24 h after surgery between two groups(P>0.05).Conclusion Dexmedetomidine hydrochloride compound local anesthetic used for thyroid surgery under anesthesia with bilateral cervical plexus block anesthesia is more hemodynamically stable and has higher postoperative patient satisfaction.