不同剂量右美托咪定辅助颈丛神经阻滞在甲状腺手术中的应用  

Application of cervical plexus nerve block assisted with different doses of dexmedetomidine on the surgery of thyroid

作　　者：顾正峰[1] 辛莲[1] 高宏[1] 王志萍[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,无锡214023

出　　处：《实用药物与临床》2013年第7期572-574,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的观察两种不同剂量右美托咪定辅助颈丛神经阻滞在甲状腺手术中的效果。方法选择ASAⅠ～Ⅱ择期拟行单侧甲状腺腺叶切除的患者40例,采用随机数字表法均分为2组,每组20例。D3组颈丛神经阻滞后,给予负荷量右美托咪定,并以0.3μg/(kg.h)维持至手术缝皮;D6组维持改为0.6μg/(kg.h)。观察并比较颈丛神经阻滞前(T0)、阻滞后5 min(T1)、阻滞后10 min(T2)、切皮时(T3)、分离甲状腺上极时(T4)和缝皮时(T5)的SBP、DBP、HR和SpO2,T0、T3、T4和T5的Ramsay评分,T3、T4、T5的VAS评分。结果在T5时,D6组SpO2低于D3组,两组比较差异有统计学意义(P<0.05),但仍在95%以上。SBP、DBP、HR、Ramsay评分、VAS评分和SpO2(T5时点除外)在各时点比较差异均无统计学意义(P>0.05)。结论颈丛神经阻滞后,右美托咪定给予负荷量并以0.3μg/(kg.h)或0.6μg/(kg.h)维持均能获得良好的镇静效果,作用安全。Objective To observe the effect of cervical plexus nerve block assisted with two different doses of dexmedetomidine applied in the surgery of thyroid.Methods 40 ASA Ⅰ~Ⅱ patients planned to undergo selective unilateral thyroid lobectomy were divided into two groups with 20 cases in each group by random number table.After cervical plexus nerve block,dexmedetomidine was maintained with a pump at the rate of 0.3 μg/（kg·h）after load dose administration and stopped at the time of skin suture in group D3,while in group D6,the maintenance rate of dexmedetomidine was changed into 0.6 μg/（kg · h）.SBP,DBP and SpO2 were observed and compared between the two groups before the cervical plexus nerve block（T0）,5 min after block（T1）,10 min after block（T2）,the time of skin incision（T3）,the time of severing the upper pole of thyroid（T4）and skin suture（T5）.The scores of Ramsay at the time of T0,T3,T4 and T5 were also observed and compared as well as the scores of VAS at T3,T4 and T5.Results The SpO2 decreased in group D6 compared with group D3 at the time of T5,there was significant difference between the two groups（P0.05）,but the SpO2 still beyond 95%.There was no significant difference in SBP,DBP,SpO2（T5 excluded）,scores of Ramsay and VAS at each different point of time（P0.05）.Conclusion Good and safe effect of sedation could be achieved by using dexmedetomidine maintained with a pump at the rate of 0.3 μg/（kg · h）or 0.6 μg/（kg · h）after load dose administration in the cervical plexus nerve block anesthesia.

关 键 词：右美托咪定 颈丛神经阻滞 甲状腺手术 

分 类 号：R614[医药卫生—麻醉学]