摘要
目的研究颈丛阻滞下对地氟醚复合瑞芬太尼用于甲状腺手术麻醉用药量、术后苏醒及疼痛的影响。方法选择60例拟行甲状腺手术的患者,随机分为全麻组（Ⅰ组）和全麻复合双侧颈浅丛阻滞组（Ⅱ组）,每组30例。全麻诱导均为咪达唑仑0.03 mg/kg,舒芬太尼0.3μg/kg,异丙酚2 mg/kg,顺式阿曲库铵0.15 mg/kg。麻醉诱导插管后,Ⅰ组吸入6%地氟醚,泵入瑞芬太尼0.1-1μg/（kg·min）维持麻醉;Ⅱ组吸入4%地氟醚,泵入瑞芬太尼0.1-1μg/kg/min维持麻醉,同时以0.375%左旋布比卡因行双侧颈浅丛阻滞。术中调整瑞芬太尼泵入速度维持BIS值在45-55之间。术毕停用所有麻醉药,记录呼吸恢复时间、苏醒时间、拔管时间、术中知晓发生率;记录苏醒后0、2、4、8、12、24 h静息及运动（吞咽）的视觉模拟评分（VAS）;计算瑞芬太尼用药量。结果Ⅰ组苏醒后0、2、4、8、12h静息及运动（吞咽）的视觉模拟评分（VAS）显著高于Ⅱ组（P≤0.05）,苏醒后24h的VAS无显著差异（P〉0.05）;Ⅰ组的呼吸恢复时间、苏醒时间、拔管时间短于Ⅱ组（P≤0.05）;Ⅰ组的瑞芬太尼用药量大于Ⅱ组（P≤0.05）;所有患者术中均无术中知晓发生。结论全麻复合双侧颈浅丛神经阻滞可有效降低术中地氟醚和瑞芬太尼用量,缩短术后呼吸恢复时间、苏醒时间、拔管时间,减轻术后疼痛。
Objective： To investigate the effect of cervical plexus block on the dosage of anesthetics,the degree of postoperative recovery and pain during desflurane combined with remifentanil anesthesia for thyroid surgery. Methods： Sixty patients having elective thyroid surgery under general anesthesia were allocated randomly into two groups： groupⅠand groupⅡ,with 30 cases in each. We used Midazolam 0. 03 mg / kg,Sufentanil 0. 3μg / kg,propofol 2mg / kg and cis atracurium0. 15 mg / kg during the induction of anesthesia in both group. GroupⅠ adopted inhalation-intravenous general anesthesia,group Ⅱadopted inhalation-intravenous general anesthesia combined with cervical plexus block on both sides. After tracheal intubation,the depth of anesthesia was maintained by 6% desflurane and remifentanil 0. 1 - 1 μg / kg / min in group Ⅰand4% desflurane,remifentanil 0. 1 - 1μg /（ kg·min） and bilateral superficial cervical plexus block using 0. 375% levobupivacaine in group Ⅱ. The speed of remifentanil was adjusted to maintain BIS values between 45 - 55 in the surgery. Breathing recovery time,awakening time,extubation time and the incidence of intraoperative awareness were recorded after the sugery. The resting and exercise（ swallowing） visual analog scale（ VAS） after awaking 0,2,4,8,12,24 h,and calculated remifentanil dosage were recorded. Results： The visual analog scale（ VAS） after waking 0,2,4,8,12 h in group Ⅰwas significantly higher than that in group Ⅱ（ P≤0. 05）. There was no significant difference in VAS after waking 24h（ P〈0. 05）. The breathing recovery time,awakening time and extubation time in group Ⅰ were shorter than those in group Ⅱ（ P≤0. 05）; The dosage of remifentanil in groupⅠwas greater than that in Ⅱ group（ P≤0. 05）. All patients had no intraoperative awareness. Conclusion： General anesthesia combined with bilateral superficial cervical plexus block can effectively reduce dosage of desflurane and remifentanil in the surgery,shorten postope
出处
《泰山医学院学报》
CAS
2015年第11期1212-1214,共3页
Journal of Taishan Medical College
关键词
颈丛阻滞
地氟醚
瑞芬太尼
甲状腺
麻醉苏醒
术后疼痛
cervical plexus block
desflurane
remifentanil
thyroid
anesthesia recovery
postoperative pain
