咪达唑仑联合芬太尼在预防颈丛阻滞甲状腺手术应激的应用

目的观察咪达唑仑联合芬太尼在预防颈丛阻滞甲状腺手术应激的作用。方法将66例甲状腺手术患者随机分为观察组及对照组各33例,两组均以鲁米那、阿托品等作为基础麻醉药,颈丛神经阻滞成功后,对照组患者单纯给予静脉注射咪达唑仑0.1mg/kg,观察组在此基础上给予芬太尼1μg/kg;分别测量麻醉前（T0）、切皮1min（T1）、取下病变甲状腺组织（T2）及结束手术（T3）的平均动脉压（MAP）、心率（HR）;并采集以上4个时间点的静脉血进行血糖（Glu）及皮质醇（Cro）的浓度测定。结果①T0时所有患者的MAP、HR、血糖及皮质醇均在正常范围内;②组内比较显示对照组的MAP、HR、Glu及Cro的变化幅度较大（P=0.042,0.026,0.036,0.000）,尤其以T1时相的变化明显,而观察组患者的变化相对平稳,多在正常范围内;③组间比较显示观察组患者在T1、T2及T3的MAP、HR、Glu及Cro均明显低于对照组（P〈0.05）。结论咪达唑仑联用芬太尼可更加有效降低颈丛阻滞甲状腺手术患者的应激反应从而提高麻醉的安全性。

Appiication of Midazolam Combined with Fentanyl on Stress Prevention for Thyreoid Surgery Patients Who Were Given Cervial Plexum Block

Objective To observe the application of midazolam combined with fentanyl on stress prevention for thyreoid surgery patients who were given cervial plexum block.Methods 66 cases were randomly divided into the observation group and the control group（both n=33）.The two groups were given luminal and atropine,as well as midazolam 0.1 mg/kg,for basic anesthetic.Based on this,patients in the observation group received fentanyl 1 μg/kg but the control not.The mean arterial pressure（MAP）,heart rate（HR）,blood glucose（Glu） and cortisol（Cro）,were observed and compared at the following 4 point times：pre-anaesthesia（T0）,1 min after skin discission（T1）,excision of thyroid gland（T2） and the end of operation（T3）.Results ①The MAP,HR,Glu and Cro were in the normal range at T0 for all the patients.②For the control group,the changes of MAP,HR,Glu and Cro were all significant（P =0.042,0.026,0.036,0.000）,especially at T1.Compared with the control group,MAP,HR,Glu and Cro belonging to the observation ones changed more smoothly,especially at T1,T2 and T3（P 0.05）.Conclusion Application of midazolam combined with fentanyl on stress can better help prevent thyreoid surgery patients needing cervial plexum block from stress.