右美托咪定超前镇痛在甲状旁腺功能亢进手术中的应用  

Application of preemptive analgesia with dexmedetomidine in patients undergoing hyperthyroidism surgery

作　　者：刘健[1] 李波[1] 

机构地区：[1]济南军区总医院麻醉科,250031

出　　处：《中华灾害救援医学》2015年第12期683-686,共4页Chinese Journal of Disaster Medicine

摘　　要：目的观察右美托咪定辅助颈丛神经阻滞加超前镇痛麻醉在甲状旁腺功能亢进手术治疗中的应用。方法以继发性甲状旁腺功能亢进行手术治疗的患者为研究对象,观察组采用颈丛神经阻滞麻醉联合右美托咪定超前镇痛下行甲状旁腺切除术（n=42）,对照组采用单纯颈丛神经阻滞麻醉的甲状旁腺切除术（n=30）。分别于入手术室时（T_0）、给予右美托咪定（颈丛阻滞前15 min）后3 min（T_1）、颈丛阻滞后3 min（T_2）、切皮即刻（T_3）、术中30 min（T_4）、术中60 min（T__5）、术中100 min（T_6）、术毕5 min（T_7）观察患者收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、心率（heart rate,HR）、脉搏血氧饱和度（pulse oxygen saturation,SpO_2）及镇静-躁动评分（Ramsay评分）情况。结果两组患者围术期SpO_2维持稳定。观察组：与T_0比较,患者在T_1-T_7时段SBP、DBP、HR均显著降低（P〈0.0071）：SBP由初始的（146.6±11.0）mm Hg（1 mm Hg=0.133k Pa）降低到（103.7±5.6）mm Hg,DBP由初始的（97.3±8.3）mm Hg降低到（72.6±8.1）mm Hg,HR由初始的（96.6±13.9）次/min降低到（75.4±4.8）次/min;Ramsay评分则无明显差异。对照组：T_0-T_7各时段比较,SBP、DBP、HR波动较大,均有明显的躁动：SBP由（146.2±11.1）mm Hg波动到（122.8±9.1）mm Hg,DBP由（97.2±9.4）mm Hg波动到（78.7±8.3）mm Hg,HR由（109.9±15.7）次/min波动到（85.8±14.6）次/min,Ramsay评分由（5.8±1.2）分波动到（2.2±0.0）分。与对照组相比,观察组血SBP、DBP、HR明显平稳,Ramsay评分明显优越（P〈0.05）。结论颈丛神经阻滞麻醉辅助右美托咪定超前镇痛下行甲状旁腺切除术,能有效降低患者的烦躁发生率,维持围术期患者的血流动力学的稳定,具有安全有效的镇痛、镇静效果。Objective To investigate the application of cervical plexus block in combination with preemptive analgesia of dexmedetomidine in patients undergoing hyperthyroidism surgery. Methods Patients with hyperthyroidism surgery were selected. Cervical plexus block in combination with preemptive analgesia of dexmedetomidine was applied in observation group（n=42）, while simple cervical plexus block anesthesia was applied in control group（n=30）. Systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, pulse oxygen saturation（SpO_2） and sedation-agitation score（Ramsay score） of patients were recorded as patients were admitted to operating room（T_0）, 3 min after application of dexmedetomidine which were applied 15 min before cervical plexus block（T_1）, 3 min after cervical plexus block（T_2）, skin cut（T_3）, intraoperative 30 min（T_4）, intraoperative 60 min（T_5）, intraoperative 100 min（T__6）, 5 min after operation（T_7）. Results SpO_2 of all patients was stable in perioperative period. In observation group, SBP, DBP and HR in T1-T7 were significantly lower than those in T0（P〈0.0071）： the average level of SBP was from the initial（146.6±11.0） mm Hg（1 mm Hg=0.133 k Pa） to the final（103.7±5.6） mm Hg, and DBP from（97.3±8.3） to（72.6±8.1） mm Hg, and HR from（96.6±13.9） to（75.4±4.8） beat per minute; but Ramsay score had no significant difference. In control group, SBP, DBP and HR fluctuated during T0-T7, and all patients were obviously restless： the average range of SBP, DBP, HR and Ramsay score were from（146.2±11.1） to（122.8±9.1） mm Hg,（97.2±9.4） to（78.7±8.3） mm Hg,（109.9±15.7） to（85.8±14.6） beat per minute,（5.8±1.2） to（2.2±0.0） respectively. Compared with control group, SBP, DBP and HR in observation group were more steady, Ramsay score were better, and the difference was statistically significant（P〈0.05）. Conclusions Application of cervical plexus block in combination

关 键 词：右美托咪定 超前镇痛 甲状旁腺功能亢进手术 

分 类 号：R64[医药卫生—外科学]