全身麻醉联合颈丛神经阻滞对老年甲状腺癌患者血流动力学指标、血糖和激素水平及炎性反应指标的影响

目的探讨全身麻醉联合颈丛神经阻滞(CPB)对老年甲状腺癌患者血流动力学指标、血糖和激素水平及炎性反应指标的影响。方法根据麻醉方式的不同将78例接受甲状腺癌根治术的老年甲状腺癌患者分为全麻组和联合组,每组39例。全麻组患者采用全身麻醉,联合组患者采用全身麻醉联合CPB。比较两组患者术前和术毕的血流动力学指标收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及心率(HR)],比较两组患者术后5 h的疼痛程度和苏醒指标(吞咽时间、睁眼时间、应答时间及应答状态),比较两组患者术前和术毕的血糖和激素促肾上腺皮质激素(ACTH)、皮质醇、肾上腺素及去甲肾上腺素]水平,比较术前和术后24 h两组患者的血清炎性反应指标超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)],比较两组患者的术中指标,分析两组患者的麻醉相关不良反应。结果术毕,联合组患者的SBP、DBP、MAP及HR均低于全麻组,血糖、ACTH、皮质醇、肾上腺素及去甲肾上腺素水平也均低于全麻组,差异均有统计学意义(P﹤0.05)。联合组患者术后5 h的视觉模拟评分法(VAS)评分低于全麻组,差异有统计学意义(P﹤0.05);术后,联合组患者的吞咽时间、睁眼时间和应答时间均短于全麻组,改良警觉与镇静评分(OAA/S)低于全麻组,差异均有统计学意义(P﹤0.05)。术后24 h,联合组患者的血清hs-CRP和IL-6水平均低于全麻组,差异均有统计学意义(P﹤0.05)。两组患者的手术时间、丙泊酚用量、芬太尼用量及补液量比较,差异均无统计学意义(P﹥0.05)。两组均未见严重的麻醉相关不良反应,仅有轻微头晕、恶心等不良反应,均自行缓解。结论全身麻醉联合CPB能够保障老年甲状腺癌患者术中血流动力学平稳,减轻术后应激反应与术后炎性反应,对患者术中血糖与激素水平的影响也较全身麻醉轻,术后痛感小且苏醒效果好。

Effect of general anesthesia combined with cervical plexus block on hemodynamic indicators,blood glucose and hormone levels and inflammatory reaction indicators in elderly patients with thyroid cancer

Objective To investigate the effect of general anesthesia combined with cervical plexus block(CPB)on the hemodynamic indicators,blood glucose and hormone levels and inflammatory reaction indicators in elderly patients with thyroid cancer.Method According to different anesthesia methods,78 elderly patients with thyroid cancer undergoing radical thyroidectomy were divided into general anesthesia group and combined group,39 cases in each group.The general anesthesia group was given general anesthesia,and the combined group was given general anesthesia combined with CPB.The hemodynamic indicatorssystolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP)and heart rate(HR)]before and after operation,the degree of pain in 5 hours after operation and the recovery index(swallowing time,eye opening time,response time and response state),the blood glucose and hormoneadrenocorticotropic hormone(ACTH),cortisol,epinephrine and norepinephrine]levels before and after operation,the serum inflammatory reaction indicatorshypersensitive C-reactive protein(hs-CRP)and interleukin-6(IL-6)]before operation and 24 hours after operation,as well as the intraoperative indicators were compared between the two groups.And the anesthesia related adverse reactions of the two groups were analyzed.Result After operation,the SBP,DBP,MAP and HR in the combined group were lower than those in the general anesthesia group,and the levels of blood glucose,ACTH,cortisol,epinephrine and norepinephrine in the combined group were also lower than those in the general anesthesia group(P<0.05).The visual analogue scale(VAS)score in 5 hours after operation in the combined group was lower than that in the general anesthesia group,and the difference was statistically significant(P<0.05).After operation,the swallowing time,eye opening time and response time of the combined group were shorter than those of the general anesthesia group,and the improved observer’s assessment of alertness/sedation (OAA/S) score was lower than that of the general anesthesia group,the differences were statistically significant (P<0.05). 24 hours after operation, the serum hs-CRP and IL-6 levels in thecombined group were lower than those in the general anesthesia group, and the differences were statistically significant(P<0.05). There were no significant differences in operation time, propofol dosage, fentanyl dosage and fluid replacementvolume between the two groups (P>0.05). No serious anesthesia related adverse reactions were found in the two groups,only mild dizziness, nausea and other adverse reactions were relieved by themselves. Conclusion General anesthesiacombined with CPB can ensure stable hemodynamics in elderly patients with thyroid cancer, reduce postoperative stressresponse and inflammatory reaction. It has less impact on blood glucose and hormone levels than general anesthesia, withless postoperative pain and better recovery effect.