靶控输注瑞芬太尼联合颈丛阻滞在甲状腺手术的效果观察  

THE CLINICAL OBSERVATION OF TARGET-CONTROLLED REMIFENTANIL INFUSION COMBINED WITH CERVICAL PLEXUS BLOCK IN THYROID GLAND SURGERY

作　　者：李利彪[1] 刘良田[1] 陈冬梅[1] 乌新林[2] 

机构地区：[1]内蒙古医学院附属医院麻醉科,内蒙古呼和浩特010050 [2]内蒙古医学院附属医院普外科

出　　处：《内蒙古医学院学报》2009年第5期441-444,共4页Acta Academiae Medicinae Neimongol

基　　金：内蒙古自治区自然科学基金项目(200711020922)

摘　　要：目的：评价靶控输注瑞芬太尼联合颈丛阻滞在甲状腺手术的效果。方法：择期行单侧甲状腺结节切除术病人40例,随机分为瑞芬太尼组（R组）和对照组（C组）两组。颈丛阻滞满意后,R组靶控输注瑞芬太尼,手术结束前5min停药;C组静脉注入氟芬合剂2mL。记录两组颈丛阻滞前（T0）、颈丛阻滞后10min（T1）、手术开始后5min（T2）、30min（T3）、术中牵拉明显时（T4）和术毕（T5）各时点的心率（HR）、动脉血氧饱和度（SaO2）、平均动脉压（MAP）、BIS、Ramsay评分及VPS评分;记录呼吸抑制、恶心呕吐及术后皮肤瘙痒等不良反应的发生情况。结果：R组各时点MAP、SaO2和BIS与T0时比较无统计学意义（P〉0.05）,Ramsay评分均为2-3分及VPS评分0-1分;C组T2-T5各时点与T0时比较MAP和HR均升高有统计学意义（P〈0.05）、BIS下降（P〈0.05）且较R组同时点均升高（P〈0.05）,Ramsay评分及VPS评分在T2-T5各时点均较T0时点高（P〈0.05）且较R组同时点均升高（P〈0.05）。结论：瑞芬太尼靶控联合颈丛阻滞用于甲状腺手术安全有效,可以达到清醒镇痛的目的,是该手术较好的一种麻醉方法。Objective：To evaluate the safety and efficency of target-controlled remifentanil infusion（CTCI） combined with cervical plexus block in thyroid gland surgery.Methods：Forty ASA I or Ⅱ patients undergoing lump of thyroid gland were randomly divided into 2 groups（n=20）：group R and group C.After a successful cervical plexus block,in group R TCI of remifentanil was started at a target plasma concentration（Cp） of 1.5ng/mL 5min before operation.Stopping injection 5 miniutes before the end of surgery.And innovar 2mL were intravenous administration in group C. MAP, HR,SaO2, BIS, Ramsay sedation score and VPS were monitored and recorded before cervical plexus block （To, baseline）, at 10 min after cervical plexus block （T1） ,5 rain （T2 ） ,30 min （T3 ） after skin incision,when the resonse was significant during operation （ T4 ） and at the end of operation （T5）. Results ：MAP,SaO2 and BIS were not significantly changed during operation as compared to the baseline values at To,the Ramsay score reached 2 -3 and the VPS reached 0 - 1 in the majority of patients in group R. MAP and SaO2 were increased during operation compared to the baseline values and the values at the same time of group R in group C, and the BIS were descended. The Ramsay score and the VPS were also increased during operation compared to the baseline values and the values at the same time of group R in group C. Conclusion： TCI of remifentanil combined with cervical plexus block can safely and effectively induce awake analgesia in patients undergoing thyroid gland operation.

关 键 词：靶控输注 颈丛阻滞 甲状腺 镇痛 

分 类 号：R917[医药卫生—药物分析学]