颈丛阻滞复合全麻用于甲亢病人手术的临床观察

目的:观察颈丛阻滞复合全麻对甲亢病人血流动力学、术毕清醒时间及术后镇痛剂使用率的影响。方法:甲亢患者行双侧甲状腺次全切除术40例,ASAⅡ~Ⅲ级,随机分A、B两组,每组各20例,A组:0.25%布比卡因行双侧颈浅神经阻滞,每侧10ml,然后缓慢依次静注咪唑安定、异丙酚、芬太尼、琥珀胆碱全麻诱导,插管成功后麻醉机控制呼吸,术中静注芬太尼、吸入1%~1.5%异氟醚维持麻醉,万可松维持肌松;B组,直接进行全麻诱导。分别记录两组患者麻醉前、插管、术中切甲状腺及拔管时的SBP、DBP、HR变化,术毕清醒时间,及术后疼痛情况。结果:两组患者术前血压和心率无显著差异。插管、术中切甲状腺及拔管时B组SBP、DBP、HR比术前明显升高(P<0.01);而A组与术前相比无明显变化(P>0.05)。B组术毕拔管时间(13±5.6)min,A组术毕拔管时间(6±3.3)min,两组相比差异非常显著(P<0.01)。A组术后镇痛剂使用率5%(1/20),B组术后镇痛剂使用率85%(17/20),两组相比差异非常显著,P<0.01。结论:在甲亢病人手术中,颈丛阻滞复合全麻比单纯全麻更能维持血流动力学稳定,减少术中静脉用药,缩短患者术毕拔管时间,减少术后镇痛剂的使用率。从而提高了甲亢患者手术的安全性。

Clinical observation of cervical plexus block combined with general anesthesia in hyperthyroid patients

Objective:To investigate the effect of cervical plexus block(CPB)combined with general anesthesia(GA)on the hemodynamics,interval of postoperative recovery from anesthesia and frequency of analgesic in hyperthyroid patients.Methods:Forty ASA II or III hyperthyroid patients undergone subtotal bilateral thyroidectomy were randomly divided into group A and B with 20 cases each.Each patient in group A was provided bilateral cervical plexus block with 0.25% bupivacaine(10 ml for each side).General anesthesia was followed by induction of intravenously administering midazolam,propofol,fentanyl and anectine.1%～1.5% isoflurane was used for anesthesia maintenance and norcuron,for muscle relaxant.Patients in group B were directly induced by general anesthesia.The notes in two groups were kept for evaluating the changes of BP and HR pre-or post-induction,phase of intubation,performance of thyroidectomy,instant variation of SBP,DBP and HR during removal of the tube,postoperative consciousness pain relief.Results:The results showed no changes in BP and HR in both groups.SBP,DBP and HR in group B were markedly increased during induction,performance of thyroidectomy and extubation while there were no changes in group A(P>0.05).The removal session of the tube in group B was(13±5.6)min compared with(6±3.3)min in group A,which revealed significant difference between the two groups(P<0.01).85%(17/20)patients in group B required pain-killer after operation compared with 5%(1/20)in group A and that indicated significant difference(P<0.01).Conclusion:CPB combined with GA in thyroidectomy can be of great benefit to hyperthyroid patients for its stabilized hemodynamics,less frequency of anesthesia,shortened time of out-tube and less requirement of postoperative analgesic.