颈浅丛阻滞复合全凭七氟烷吸入维持气管内全麻在甲状腺手术的临床观察

目的对比颈浅丛阻滞复合全凭七氟烷吸入维持气管内全麻和单纯静脉复合气管内全麻应用于甲状腺手术的麻醉效果。方法 40例行双侧甲状腺次全切除手术的全麻患者,随机分为A、B两组,A组采用颈浅丛阻滞复合全凭七氟烷吸入维持气管内全麻,B组采用单纯静脉复合气管内全麻。A组在全麻前行颈浅丛阻滞,在常规麻醉诱导插管后,麻醉维持A组用2%～3%七氟烷吸入,B组用瑞芬太尼0.1～0.2μg/(kg·min)并复合持续静脉输注异丙酚,记录气管插管、切皮、麻醉维持和气管拔管时血压(MAP)和心率(HR)的变化,术毕自主呼吸恢复、拔管和完全清醒时间,以及术后疼痛情况。结果两组诱导前后MAP、HR无明显差异,A组切皮、麻醉维持时浅麻醉发生率明显低于B组(P<0.05);术毕自主呼吸恢复、拔管和完全清醒时间,A组较B组明显缩短(P<0.01);B组术后疼痛的人数明显多于A组(P<0.01)。结论颈浅丛阻滞复合全凭七氟烷吸入维持气管内全麻在甲状腺手术时维持血流动力学稳定方面明显优于单纯静脉复合气管内全麻,苏醒快速,并可减轻术后疼痛,有良好的临床效果。

Clinical observation of superficial cervical plexus block combined with all by sevoflurane inhaled maintain general anesthesia in the thyroid surgery

Objective To contrast the effect of superficial cervical plexus block combined with all by sevoflurane inhaled maintain general anesthesia and pure compound vein endotracheal anesthesia in the thyroid surgery.Methods 40 paitients who accepted subtotal thyroidectomy were randomly allocated into two groups of A and B,with 20 patients in each group.Group A adopted superficial cervical plexus block combined with all by sevoflurane inhaled maintain general anesthesia,group B adopted pure compound vein endotracheal anesthesia.Before general anesthesia,group A adopted superficial cervical plexus block.After tracheal intubation,anesthesia was maintained by 2%～3% sevoflurane inhaled completely in group A and remifentanil 0.1～0.2 μg/（kg/min）in group B with an intravenous infusion of propofol.Heart rate and blood pressure were recorded at the following time points：at intubation,skin incision,anesthetic maintenance and extubation.The time of spontaneous breathing recovery after operation,exintubation,completely awake and postoperative pain were also recorded.Results Before and after induction, the difference of MAP and HR was not significant in two groups. But the rate of light anesthesia was lower in group A than in group B during the period of skin incision and anesthetic main- tenance（P0.05）.The time of spontaneous breathing recovery after operation,exintubation and completely awake in group A was shorter than that in group B（P〈0.01）.More postoperative paitients felt pain obviously in group B （P〈0.01）.Conclusion Hemodynamics are more stable in superficial cervical plexus block combined with all by sevoflurane inhaled maintain general anesthesia in the thyroid surgery than in pure compound vein endotracheal anesthesia.The combines anaesthesia also can make paitients come to wake quickly and reduce postoperative pain.