超声引导下颈中间丛阻滞联合甲状腺囊下阻滞用于微波消融甲状腺结节

Ultrasound-guided intermediate cervical plexus block combined with thyroid subcapsular block for microwave ablation of thyroid nodules

目的观察超声引导下颈中间丛阻滞(ICPB)联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。方法前瞻性纳入68例单发结节性甲状腺肿患者,随机将其分为干预组(n=34)和对照组(n=34)。对干预组于超声引导下ICPB联合甲状腺囊下阻滞消融,对照组于常规局部浸润麻醉后行甲状腺结节微波消融,对比组间一般资料、术中及术后情况,消融过程及消融后2、4、8及24 h分别记为T1、T2、T3、T4及T5。评价ICPB联合甲状腺囊下阻滞用于微波消融甲状腺结节的价值。结果最终60例入组,干预组、对照组各30例;干预组患者T1~T3期间心率-血压乘积(RPP)及T1~T4期间视觉模拟量表(VAS)评分均显著低于对照组(P均<0.05),而T2及T3期间40项恢复质量(QoR-40)评分显著高于对照组(P均<0.05)。干预组术中接受利多卡因者占比及剂量、术后口服对乙酰氨基酚占比及剂量均显著低于对照组(P均<0.05)。干预组术后未见明显并发症,对照组术后4例声嘶、2例呕吐。结论超声引导下ICPB联合甲状腺囊下阻滞用于甲状腺结节微波消融安全性较高,可提供有效围手术期镇痛。

Objective To observe the value of ultrasound-guided intermediate cervical plexus block(ICPB) combined with thyroid subcapsular block for microwave ablation of thyroid nodules. Methods Sixty-eight patients with solitary nodular goiter were prospectively enrolled and randomly divided into intervention group(n=34) or control group(n=34). Patients in intervention group underwent ultrasound-guided ICPB combined with thyroid subcapsular block, while those in control group underwent routine local infiltration anesthesia, and microwave ablations of thyroid nodules were performed. Patients’ general data, the intraoperative and postoperative conditions were observed and compared between groups. The ablation process was denoted as T1, and 2, 4, 8 and 24 h post-ablation were denoted as T2, T3, T4 and T5, respectively. The value of ICPB combined with thyroid subcapsular block was analyzed. Results Sixty cases were finally enrolled, including 30 cases in each group. The rate-pressure product(RPP) during T1—T3 and visual analogue scale(VAS) during T1—T4 of intervention group were significantly lower than those of control group(both P<0.05), and the ratio of patients received lidocaine during operation and/or received acetaminophen after operation as well as the dosages in intervention group were significantly lower than those in control group(all P<0.05). No obvious complication occurred in intervention group after operation, while hoarseness and vomiting occurred in 4 cases and 2 cases in control group, respectively. Conclusion Ultrasound-guided ICPB combined with thyroid subcapsular block for microwave ablation of thyroid nodules was safe and able to provide effective perioperative analgesia.