甲状腺腺癌病人的麻醉(附50例分析)

目的：采用两种不同的颈丛神经阻滞方法应用于甲状腺腺瘤切除术，比较其麻醉效果及对循环的影响。方法：50例ASAⅠ－Ⅱ级择期甲状腺腺瘤病人，随机分成两组，每组25例。Ⅰ组采用C3深丛阻滞（相当于C3横突处一点）及浅丛阻滞法（胸锁乳突肌后缘中点）;Ⅱ组用C3、C4深丛阻滞法（相当于C3、C4横突处各一点）及浅丛阻滞法。均以20ml注射器及v号3．5cm针头进行须深丛和颈浅丛神经阻滞。颈深丛阻滞注入1．14％利多卡因与0．14％丁哌卡因混合液，单测一点4~6ml，两点即8－12ml，双侧一点8~12ml，两点即16~24ml（均不加肾上腺素）。颈浅丛阻滞用1．33％利多卡因及0．25％布比卡因，单侧10ml，双侧20ml。观察两组阻滞前后BP和HR变化情况。结论：两组阻滞麻醉效果没有显著性差异，但是两种阻滞方法对循环的影响却不同，有显著性差异（P＜0．05）。从阻滞后5~30minBP升高平均值和HR增加方面看Ⅰ组对循环影响较轻，Ⅱ组则较大。C3主要支配颈部区域，浅丛支配皮肤和浅表结构，对甲状腺腺瘤手术来说，二者配合应用，麻醉效果满意，用药量小，对迷走神经阻滞较轻，对循环系统影响相对轻，副作用小，值得应用。

Clinical Experience of Anesthesia on Thyroid Adenoma

objective: To compare with the anesthesia effect and its affection to circulation between different cervical plexusblock methods on thyroid adenoma patients. Methods: 50 cases of thyroid adenoma pahents were divided into two groups randomly with different methods blocking inferior and superior hranches of C3 in Croup Ⅰ and inferior branches of C3 and C4in group Ⅱ. Results: Both groups had obtained good anesthesia effects, but there was sigificantly different hetween twogroups in affection on circulation. Conclusion: There was less affection and side effect in Group Ⅰon cireulation and thismethod could be applied in clinic.