全身麻醉和颈丛阻滞对甲状腺切除患者FT3、FT4和皮质醇水平的影响  

Effects of general anesthesia and cervical plexus block on FT3,FT4 and cortisol in patients undergoing thyroidectomy

作　　者：黄其健[1] 公维义[1] 郭永正[1] 

机构地区：[1]福建医科大学附属协和医院麻醉科,350001

出　　处：《福建医药杂志》2009年第4期97-99,共3页Fujian Medical Journal

摘　　要：目的探讨全身麻醉与颈丛阻滞对甲状腺切除患者游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和皮质醇水平的影响。方法将40例ASAⅠ或Ⅱ级行单侧甲状腺叶切除患者随机均分为全身麻醉组(Ⅰ组)和颈丛阻滞组(Ⅱ组)。记录麻醉前10min(S0)、气管插管后及颈丛阻滞后即刻(S1)、手术切皮(S2)、分离甲状腺上极(S3)和手术结束(S4)时的收缩压(SBP)、舒张压(DBP)、HR和脉搏氧饱和度(SpO2);取静脉血测定FT3、FT4和皮质醇。结果Ⅱ组S1、S2和S3时的SBP、DBP和HR高于Ⅰ组(P<0.05),且S3时的SBP、DBP和HR高于其他时间点(P<0.05)。与Ⅰ组比较,Ⅱ组FT3在S4时,FT4在S2、S3和S4时,皮质醇在S1、S2、S3和S4时升高(P<0.05);与组内其他时间点比较,Ⅰ组FT4在S3时,Ⅱ组FT4在S1、S2和S3时升高(P<0.05),而皮质醇在Ⅱ组S2和S3时升高(P<0.05)。结论全身麻醉行甲状腺切除术,血流动力学稳定、应激反应小。Objective To investigate effects of general anesthesia and cervical plexus block on free triiodothyronine （FT3）, free thyroxine （FT4） and cortisol in patients undergoing thyroidectomy. Methods Forty ASA Ⅰ or Ⅱ patients undergoing thyroidectomy were randomly divided into group general anesthesia （group Ⅰ ） and group cervical plexus block （group Ⅱ ）. BP, HR and SpO2 were recorded at 10 min before anesthesia, immediately after intubation or cervical plexus block, skin was cut, upper pole of thyroid gland was separated and operation was accomplished. Meanwhile, blood samples were taken for measurement of FT3, FT4, and cortisol. Results SBP, DBP and HR at S1, S2 and S3 were higher in group Ⅱ than in group Ⅰ （P〈0.05）. In group Ⅱ , SBP, DBP and HR at S3 was higher than other times （P〈0.05）. FT3 at S4, FT4 at S2, S3 and.S4 and cortisol at S1 , S2 , S3 and S4 were significant higher in group Ⅱ than in group Ⅰ （P〈0.05）. FT4 at S3 was higher than other times in group Ⅱ and FT4 at S1 , S2 and S3 and cortisol at S2 and S3 were higher than other times in group Ⅱ （P〈 0.05）. Conclusion Hemodynamics is more stable and stress reaction is slighter in patients undergoing thyroidectomy during general anesthesia.

关 键 词：全身麻醉 颈丛阻滞 甲状腺切除术 应激反应 

分 类 号：R614[医药卫生—麻醉学]