双侧甲状腺次全切除术靶控输注瑞芬太尼联合颈丛阻滞的效果

目的评价双侧甲状腺次全切除术患者靶控输注瑞芬太尼联合颈丛阻滞的效果。方法择期行双侧甲状腺次全切除术的患者30例，ASAⅠ或Ⅱ级，年龄30～64岁，颈丛阻滞满意后，在手术开始前5min靶控输注瑞芬太尼，初始血浆靶浓度为1．6ng／ml，术中根据患者情况及手术刺激强度调整目标浓度，每次递增或递减0．2ng／ml，直至镇静达Ramsay镇静评分2～3分，或镇痛达口述镇痛评分（VPS）0～1分，手术结束前5rain停药。于颈丛阻滞前（TO）、颈丛阻滞后10min（T1）、手术开始后5min（T2）、30min（T3）、术中气管牵拉明显时（T4）和术毕（T5）记录平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、Ramsay评分及VPS评分；记录呼吸抑制、肌肉僵硬、恶心呕吐及皮肤瘙痒等不良反应的发生情况；记录每例患者瑞芬太尼的最大血浆靶浓度，计算其平均血浆靶浓度。结果与TO时比较，各时点MAP、SpO2差异无统计学意义（P〉0．05）Ramsay评分和VPS评分T2时开始升高，T3、T4时达高峰，T5时下降（P〈0．05），Ramsay评分均为2～3分，VPS评分均为0～1分，镇静镇痛效果良好。无一例发生不良反应。瑞芬太尼的最终血浆靶浓度范围为1．6～5ng／ml，平均维持浓度为（3．4±1．0）ng／ml。结论瑞芬太尼低血浆靶浓度TCI联合颈丛阻滞用于双侧甲状腺次全切除术安全有效，可以达到清醒镇痛的目的，且无明显不良反应。

Effect of target controlled infusion of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy

Objective To evaluate the effect of target controlled infusion （TCI） of Remifentanil combined with cervical plexus block in patients with bilateral subtotal thyroidectomy.Methods 30 cases of ASA Ⅰ -Ⅱpatients with selective bilateral subtotal thyroidectomy,the ages between 30 to 64 years old, received TCI of Remifentanil after satisfactory cervical plexus block 5 minutes before operations.Initial target plasma concentration was 1.6ng/ml.During operation, adjusted the target concentration according to the patients？ situation and the stimulating intensity, increasing or decreasing d 0.2ng/ml by degrees every time, until reached the Ramsay sedation scale at 2 - 3 score. Or, the sedation reached verbal pain scores （VPS） at 0 - 1 score. Then, the patients were stopped taking the medicine 5 minutes before the end of operation. Recorded the mean arterial pressure （MAP）, heart rate （HR）, pulse,oxygen saturation （SpO2 ）, Ramsay sedation scale, and VPS at the time before cervical plexus block （To）, the time after cervical plexus block （T1）, 5 minutes after operation（T2）, 30 minutes after operation（T3）, trachea were pulled in evidence（T4）, and at the end of operation （T5）.Recorded the appearance adverse reactions including： respiratory inhibition, muscles stiffness, nausea and vomitting, Itch of skin, etc.And, recorded the biggest plasma target concentration and calculated the average plasma target concentration.Results Comparing with T0,the MAP, SpO2 at every time was short of statistic significance （P〉 0.05）, Ramsay sedation scale and VPS began to hoist at T2 reached pinnacle at T3, T4, and descended at T5（P〈 0.05）, all Ramsay sedation scale at 2 - 3 score and VPS at 0 - 1 score. The effect of sedation and analgesia were excellent. There was no adverse event occurred. The final plasma target concentration of Remifentanil was 1.6 - 5ng/ml.The maintained average concentration was （3.4± 1.0）ng/ml.Conclusions The effect of target controlled infusion （TCI）