超声引导颈丛阻滞与可视喉罩在甲状腺癌手术中的联合应用

Combined Application of Ultrasound-Guided Cervical Plexus Block and Visual Laryngeal Mask Airway General Anesthesia in Radical Thyroid Cancer Surgery

目的研究超声引导下颈丛神经阻滞联合可视喉罩全麻在甲状腺癌根治手术中的应用价值。方法选择2021年6月—2022年5月60例行甲状腺癌根治手术的患者,随机分为两组,每组30例。两组患者术前半小时肌注咪达唑仑0.04 mg/kg+阿托品0.075 mg/kg。观察组采用超声引导下颈丛神经阻滞联合SaCoVLM喉罩全麻(CS组),对照组为局部切口浸润联合气管插管全麻(RI组)。颈丛神经阻滞在超声引导下完成,患侧深丛6 mL+浅丛4 mL,对侧仅阻滞浅丛4 mL。局部切口浸润在切皮前完成,剂量14 mL。局麻药均为0.33%罗哌卡因。CS组颈丛阻滞完善后,行麻醉诱导插入喉罩(经配套可视视屏证实);RI组在可视喉镜下插入气管导管。诱导用药:0.3 mg/kg依托咪酯、2~3μg/kg芬太尼、0.2 mg/kg顺式阿曲库铵。术中丙泊酚TCI泵入+七氟醚吸入,手术结束待患者清醒后将气管导管/喉罩拔除。术中维持脑电双频指数(bispectral index,BIS)值45~60,必要时追加芬太尼和顺式阿曲库铵。结果CS组患者苏醒时间、拔管/喉罩时间及麻醉后监测治疗室停留时间短于RI组(P<0.05);CS组患者全麻药物(丙泊酚、芬太尼)的用量少于对照组,差异有统计学意义(P<0.05);与RI组患者相比,CS组患者的术后4 h视觉模拟评分(visual analogue scale,VAS)降低(P<0.05),术后并发症恶心呕吐和咽喉不适发生率减少(P<0.05)。两组患者均无发生恶性高血压、术后呼吸抑制等严重并发症。结论超声引导下颈丛神经阻滞与可视喉罩联合用于甲状腺癌根治手术,术中使用麻醉药更少,苏醒期平稳过渡,围手术期并发症少,同时达到术后镇痛效果。

Objective To investigate the value of ultrasoundguided cervical plexus block combined with visual laryngeal mask airway(LMA)general anesthesia in radical thyroid cancer surgery Methods A total of 60 patients undergoing radical thyroid cancer surgery from June 2021 to May 2022 were randomly divided into two groups,30 cases in each group.0.04 mg/kg midazolam and 0.075 mg/kg atropine were injected intramuscularly half an hour before operation.The observation group was given cervical plexus block guided by ultrasound combined with SaCoVLM LMA general anesthesia(CS group).The control group was local infiltration anesthesia combined with general anesthesia for tracheal intubation(RI group).Cervical plexus block was performed under ultrasound guidance,6 mL anaesthetic was injected on the affected side deep plexus of cervical plexus,4 mL anaesthetic was injected on the affected side superficial plexus of cervical plexus.On the opposite side,only 4 mL anaesthetic was injected in superficial plexus.Local incisions infiltrate before skin incision,the dosage was 14 mL.All local anesthetics were 0.33%ropivacaine.CS group was inserted LMA(confirmed by the supporting video)under anesthesia induction after the block of cervical plexus was completed.RI group was inserted trachea catheter under visual laryngoscope.Induction drugs were 0.3 mg/kg etomidate,2-3μg/kg fentanyl and 0.2 mg/kg cis-atracurium.Propofol was pumped in with TCI and Sevoflurane was inhaled during the operation.Tracheal Catheter or LMA was removed if the patient regained consciousness after operation.bispectral index(BIS)was maintained at 45-60 during operation.Add fentanyl and cisatracurium if there were necessary.Results The recovery time,the time of extubation and the time of stay in postanesthesia care unit in CS Group were shorter than those in RI group(P<0.05).The dosage of propofol and fentanyl in CS group were less than that in control group,the difference was statistically significant(P<0.05).Compared with RI group,the visual analogue score(VAS)score of CS group decreased at 4 hours after operation(P<0.05).The incidence of postoperative complications such as nausea,vomiting and throat discomfort was reduced(P<0.05).No serious complications such as malignant hypertension and postoperative respiratory depression occurred in both groups.Conclusion The combination of ultrasound-guided cervical plexus block and LMA general anesthesia were used in radical thyroid cancer surgery,with less anesthesia,stable recovery and less perioperative complications,and better postoperative analgesia.