右美托咪定复合颈浅丛阻滞对甲状腺手术麻醉效果的影响

目的:探讨右美托咪定联合颈浅神经丛阻滞对甲状腺手术麻醉效果的影响.方法:选择2013年6月~2016年6月在我院行甲状腺手术的患者80例,随机分为对照组(A组)和实验组(B组),每组40例.B组患者术中静脉泵注负荷剂量1.0μg/kg右美托咪定,之后以0.6~0.8μg/kg·h维持,A组泵注同容量的生理盐水.分别记录患者麻醉前,切皮时,分离腺体,腺体切除,切口缝合等时间点的HR、MAP、SpO2、RR等生命体征和Ramsay镇静评分;比较两组患者术中内脏牵拉反应的改善情况以及术后不良反应的发生情况.结果:B组患者的HR、MAP较A组低,差异具有统计学意义,两组患者SpO2变化不显著.结果显示B组患者T0~T2时间段呼吸频率与A组比较较少,且差异显著.比较两组患者术中不同时间点的Ramsay镇静评分,发现手术开始之后B组患者的镇静状态优于A组.B组患者术中内脏牵拉反应的改善情况优于A组患者.术后苏醒期60 min时,B组患者较A组患者安静,没有明显的躁动行为.记录患者术后不良反应的发生情况,B组患者发生恶心呕吐及呼吸抑制等不良反应的发生率明显低于A组.结论:右美托咪定联合颈浅神经丛阻滞对行甲状腺切除术的患者有明显的镇静作用,可以稳定血流动力学,降低恶心呕吐及呼吸抑制等不良反应的发生率,为临床上改善麻醉效果提供一定的依据.

The influence of dexmedetomidine combined with superficial cervical plexus blocking on the anesthetic effect of thyroid surgery

Objective To explore the influence of dexmedetomidine combined with superficial cervical plexus blocking on the anesthetic effect of thyroid surgery.Methods 80 patients undergoing thyroid surgery in our hospital from July 2013 to July 2016, of all patients were divided into two groups, control group (Group A, n=40) and study group (Group B, n=40). The patients of Group A accepted intravenous infusion dexmedetomidine with1 g/kg loading dose, and after maintenance dexmedetomidine with 0.6~0.8μg/kg·h, ; Group A pumped with the same volume of physiological saline. The HR, MAP, SpO2, RR and Ramsay score at the time point of before anesthesia, skin incision, gland separation, gland resection and suture were recorded. The im-provement of visceral traction reaction in operation and adverse reaction in post operation were compared between two groups. Results The HR and MAP of patients in Group B were lower than that in Group B, and which difference was statistical signifi-cance, and the difference of SpO2 in two groups was not significance; The RR of patients in Group B at the time T0~T2 was fewer than that in Group B, and which difference from two groups was significance; The Ramsay score at the different time point was compared, and the postoperative sedation state in Group B was better than that in Group A. The improvement of visceral traction in Group B was also better than that Group A. After operation, the patients of Group B with recovery period60 min were quiet and no obvious agitation behavior compared with Group A. The adverse reaction in postoperative was recoded, and the in-cidence of nausea and vomiting, respiratory depression were significantly lower than that in Group A.Conclusion Dexmedeto-midine combined with superficial cervical plexus blocking possessed obvious sedation for patients undergoing thyroidectomy, which not only stabilized hemodynamics, but also decreased the incidence of nausea and vomiting, respiratory depression, pro-viding a basis for improving the effect of anesthesia in clinic.