颈丛阻滞联合全身麻醉在CRF继发SPHT患者行甲状旁腺次全切除术中的应用  

Application of the cervical plexus block plus general anesthesia in the subtotal parathyroidectomy in uremia patients with secondary hyperparathyroidism

作　　者：宿颖岚[1,2] 张中军 戴中亮[1,2] 

机构地区：[1]暨南大学第二临床医学院 [2]广东省深圳市人民医院麻醉科,518020

出　　处：《广东医学》2014年第11期1669-1672,共4页Guangdong Medical Journal

基　　金：广东省深圳市科技计划项目(医疗卫生类)一般项目(编号:201302002)

摘　　要：目的：比较单纯气管插管全麻与气管插管全麻联合颈丛神经阻滞用于慢性肾功能衰竭（ CRF）继发甲状旁腺功能亢进（SPHT）患者行甲状旁腺次全切除术的优、缺点。方法选择60例择期行甲状旁腺次全切除术的 CRF 继发 PHT 患者，ASAⅢ～Ⅳ级，分为3组：单纯全麻（GA）组、全麻联合双侧颈浅丛（BS）组和全麻联合双侧颈深浅丛（BD）组。每组20例。GA 组采用1％利多卡因与0.5％罗哌卡因混合液，经传统的一点法进行颈丛神经阻滞。BD 组每侧颈深、浅丛各注入5 mL，共计20 mL；BS 组每侧颈浅神经丛注入5 mL，共计10 mL。3组患者全麻插管诱导及维持采用相同的方法及药物，BS 组和 BD 组插入气管导管后行颈丛神经阻滞。监测并记录3组患者的血流动力学相关指标和神经内分泌应激激素水平的变化，拔管时间，拔管前、后躁动的发生率，术中全麻药物的用量等。结果 BS 组和 BD 组患者各项指标均优于 GA 组（P 〈0.05），其中又以 BD 组更为满意。结论气管插管全麻联合颈丛神经阻滞，特别是全麻联合双侧颈深浅丛阻滞是 CRF 继发 HPT 患者行甲状旁腺次全切除术的一种较为理想的麻醉方法。Objective To compare the efficacy and safety between single general anesthesia and general anesthe-sia plus cervical plexus block for the subtotal parathyroidectomy of uremia patients with secondary hyperparathyroid-ismMethods A total of 60 patients（ASA Ⅱ - Ⅲ）with subtotal parathyroidectomy were randomly divided into three groups（n = 20）：general anesthesia（GA group）,general anesthesia plus bilateral superficial cervical plexus block（BS group）and general anesthesia plus combined bilateral deep and superficial cervical plexus block（BD group）. Anesthesia was induced with midazolam,propofol,fentanyl,and cis - atracurium. In BS group and BD group,the cervical plexus blockade was performed after endotracheal intubation. The general anesthesia was maintained by continuing injection of propofol and remifentanil by infusion pump. The hemodynamic parameters and the levels of neuroendocrine stress hor-mones were monitored and recorded intermittently. The time of the extubation,the incidences of agitation before and after extubation,and the cumulative usage of general anesthetics were recorded. Results Significantly better efficacy and safe-ty of anesthesia were observed in BS group and BD than GA group（P 〈 0. 05）,especially in BS group. Conclusion For subtotal parathyroidectomy in uremia patients with secondary hyperparathyroidism,the general anesthesia plus cervical plexus block provides better efficacy and safety.

关 键 词：颈丛神经阻滞 全身麻醉 肾功能衰竭继发甲状旁腺功能亢进 甲状旁腺次全切除术 

分 类 号：R581.1[医药卫生—内分泌]