双侧MUBSCPB复合全身麻醉对甲状腺开放性手术患者麻醉恢复情况及阿片类药物用量的影响

Effects of modified ultrasound-guided bilateral superficial cervical plexus block combined with general anesthesia on anesthetic recovery and opioid use in patients undergoing open thyroid surgery

目的探讨双侧改良超声引导双侧颈浅丛阻滞(MUBSCPB)复合全身麻醉对甲状腺开放性手术患者疼痛、麻醉恢复情况及阿片类药物用量的影响,以期为临床治疗提供参考。方法选取2023年1—12月于新疆医科大学附属肿瘤医院行甲状腺开放性手术治疗的100例患者为研究对象。根据患者麻醉方法分组,将接受全身麻醉的49例患者纳入全麻组,将接受双侧MUBSCPB复合全身麻醉的51例患者纳入联合组。比较2组患者围术期指标[手术时间、麻醉时间及平均动脉压(MBP)、心率(HR)波动水平];观察2组患者清醒时、术后4 h、术后12 h、术后24 h疼痛程度[疼痛数字评价(NRS)评分];比较2组患者麻醉恢复情况(睁眼时间、自主呼吸时间、拔管时间、答问切题时间)及术中芬太尼、术后吗啡用量;比较2组患者术后24 h恢复质量[40项恢复质量评分量表(QoR-40)评分]。结果2组患者手术时间、麻醉时间比较,差异均无统计学意义(P>0.05);联合组患者MBP、HR波动水平小于全麻组,差异均有统计学意义(P<0.05)。清醒时、术后4 h、术后12 h,联合组患者NRS评分均低于全麻组,差异均有统计学意义(P<0.05)。术后24 h,2组患者NRS评分比较,差异无统计学意义(P>0.05)。联合组患者术中芬太尼用量、术后吗啡用量均小于全麻组患者,差异有统计学意义(P<0.05)。联合组患者睁眼、自主呼吸、拔管及答问切题时间均短于全麻组,差异均有统计学意义(P<0.05)。术后24 h,联合组患者QoR-40中身体舒适、情绪状态、自理能力、心理支持、疼痛评分均高于全麻组,差异均有统计学意义(P<0.05)。结论双侧MUBSCPB复合全身麻醉可缩小甲状腺开放性手术患者血流动力学指标波动范围,减轻术后疼痛,减少术中芬太尼用量及术后吗啡用量,同时促进麻醉恢复和术后康复,值得推广应用。

Objective To investigate the effects of modified ultrasound-guided bilateral superficial cervical plexus block(MUBSCPB)combined with general anesthesia on pain,anesthetic recovery,and opioid use in patients undergoing open thyroid surgery,providing clinical treatment reference.Methods The study included 100 patients who underwent open thyroid surgery at the Affiliated Tumor Hospital of Xinjiang Medical University from January to December 2023.Patients were allocated to a general anesthesia group(n=49)and a combination group(n=51)that received bilateral MUBSCPB combined with general anesthesia.Perioperative indicators,such as time of operation,anesthesia time,mean arterial pressure(MBP),and heart rate(HR)fluctuations,were compared.Pain levels were assessed using the Numerical Rating Scale(NRS)at various postoperative time points(awake,4 h after surgery,12 h post-surgery,and 24 h post-surgery).Anesthetic recovery(eye-opening time,spontaneous breathing time,extubation time,time to consciously answering questions),intraoperative fentanyl,and postoperative morphine use were compared.Quality of recovery 24 hours post-surgery was evaluated using the QoR-40 scale.Results No significant differences were observed between the groups in time of operation or anesthesia time(P>0.05).The combination group exhibited significantly lower MBP and HR fluctuations as compared with the general anesthesia group(P<0.05).NRS scores were significantly lower in the combination group at awake,4 hours,and 12 hours post-surgery(P<0.05),but not at 24 hours post-surgery(P>0.05).The combination group also re-quired significantly less fentanyl and morphine(P<0.05)and showed significantly quicker recovery times in eye-opening,spontaneous breathing,extubation,and answering questions consciously(P<0.05).Additionally,the combination group had significantly higher QoR-40 scores in physical comfort,emotional state,self-care abilities,psychological support,and pain scores(P<0.05).Conclusion The MUBSCPB combined with general anesthesia reduces hemodynamic fluctuations,alleviates postoperative pain,lowers intraoperative fentanyl and postoperative opioid use,and accelerates anesthetic recovery and postoperative rehabilitation in open thyroid surgery,making it clinically valuable.