超声引导下星状神经节阻滞对甲状腺开放切除术患者术中芬太尼用量的影响

Effect of ultrasound-guided stellate ganglion block on intraoperative fentanyl dosage in patients undergoing open thyroidectomy

目的 探讨超声引导下星状神经节阻滞(SGB)对甲状腺开放切除术患者术中芬太尼用量的影响。方法 选择2021年11月至2022年4月川北医学院附属医院择期行全身麻醉下甲状腺开放切除术的甲状腺肿瘤患者68例为研究对象,分为SGB组(S组,n=35)和对照组(C组,n=33)。S组患者在麻醉诱导前15 min行超声引导下SGB(注射0.25%丁哌卡因6~8 mL),C组麻醉诱导前15 min仅在超声引导下行星状神经节识别,不进行其他操作。患者均接受相同的脑电双频指数(BIS)监测下的麻醉诱导和维持。记录患者芬太尼用量、苏醒时间、麻醉药用量、补液量、出血量、阿托品和麻黄碱使用率、手术时间、术后并发症发生情况,以及麻醉后恢复室(PACU)30 min和术后3、6、12、24 h视觉模拟量表(VAS)评分。结果 与C组比较,S组术中芬太尼用量明显降低[(247.9±65.4)μg vs.(295.7±61.5)μg,P=0.003]。两组丙泊酚用量、顺式阿曲库铵用量、补液量、出血量、阿托品和麻黄碱使用率、苏醒时间、并发症发生率比较,差异无统计学意义(P>0.05)。S组各时点VAS评分均明显低于C组(P<0.05)。结论 超声引导下SGB可以减少甲状腺开放切除术患者术中芬太尼的用量。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB) on intraoperative fentanyl dosage in the patients undergoing open thyroidectomy.Methods A total of 70 patients with elective open thyroidectomy under general anesthesia in the Affiliated Hospital of North Sichuan Medical College from November 2021 to April 2022 were selected as the study subjects and divided into the SGB group(group S,n=35) and the control group(group C,n=33).The group S conducted ultrasound-guided SGB at 15 min before anesthetic induction(injection of 0.25% marcaine 6-8 mL),and group C conducted the stellate ganglion recognition under the ultrasound guidance in 15 min before anesthetic induction without conducting other operations.All patients all received the anesthesia induction and maintenance under the same BIS monitoring.The fentanyl dosage,recovery time,anesthetic drugs dosage,fluid infusion amounts,bleeding volume,use rate of atropine and ephedrine,operation time and postoperative complications as well as the VAS scores in PACU 30 min,at postoperative 3,6,12,24 h were recorded.Results Compared with group C,the intraoperative amount of fentanyl in group S was significantly decreased [(247.9±65.4)μg vs.(295.7±61.5)μg,P=0.003].The propofol dosage,cisatracurium dosage,fluid infusion amounts,bleeding amounts,use rate of atropine and ephedrine,recovery time and incidence rate of complications had no statistical differences between the two groups(P>0.05).The VAS scores at various time points in group S all were lower than those in group C(P<0.05).Conclusion Ultrasound-guided SGB could reduce the fentanyl use amounts during operation in the patients with open thyroidectomy.