全麻气管插管联合颈丛阻滞用于甲状腺手术的可行性和安全性分析  

Analysis for the feasibility and safety of general anesthesia endotracheal intubation combined with cervical plexus nerve block during thyroid surgery

作　　者：黄树彬 黄霓 

机构地区：[1]广东省潮州市潮安区人民医院麻醉科,515638 [2]广东省潮州市人民医院麻醉科

出　　处：《河北医药》2016年第21期3230-3233,共4页Hebei Medical Journal

摘　　要：目的探讨气管插管下全身麻醉联合颈丛神经阻滞用于甲状腺手术的可行性和安全性。方法选取甲状腺手术患者89例,随机分为2组,对照组44例采用全麻气管插管,观察组45例采用全麻气管插管联合颈丛神经阻滞。比较2组麻醉诱导前（T0）、气管插管前1 min（T1）、气管插管后1 min（T2）、切皮后1 min（T3）、病灶切除时（T4）、手术结束时（T5）平均动脉压（MAP）、心率（HR）、血浆促甲状腺激素（TSH）、皮质醇（Cor）水平,VAS评分,首次镇痛时间,镇痛药用量与恶心呕吐发生率的差异。结果 T3~T4期间,观察组MAP、HR水平明显低于对照组,血浆TSH、Cor水平明显低于对照组,差异有统计学意义（P〈0.05）。与T0比较,对照组MAP、HR水平明显增高,血浆TSH、Cor水平明显增高,差异有统计学意义（P〈0.05）。观察组术后4、8、24 h血清IL-1β与VAS评分均明显低于对照组,首次镇痛时间明显长于对照组,镇痛药用量明显少于对照组,2组比较差异均有统计学意义（P〈0.05）。2组恶心呕吐发生率比较差异无统计学意义（P〉0.05）。结论全麻气管插管联合颈丛有助于显著降低甲状腺手术患者机体应激反应程度与炎症趋化因子水平,从而显著改善术后镇痛效果,提高手术可行性与安全性,值得临床推广应用。Objective To investigate the feasibility and safety of geberal anesthesia endotracheal intubation combined with cervical plexus nerve block during thyroid surgery. Methods Eighty-nine patients who underwent thyroid surgery in our hospital were randomly divided into control group（ n = 44） and observation group（ n = 45）. The patients in control group were given general anesthesia endotracheal intubation,however,the patients in observation group were given general anesthesia endotracheal intubation combined with cervical plexus nerve block. The mean arterial pressure（ MAP）,heart rate（ HR）,the plasma levels of thyroid stimulating hormone（ TSH） and cortisol（ Cor）,visual simulation ache score（ VAS）,the first analgesia time,the analgesic dosage,incidence rates of nausea and vomiting before anesthesia induction（ T0）,1min before endotracheal intubation（ T1）,1min after endotracheal intubation（ T2）,1min after skin-cutting（ T3）,focus excision（ T4）,surgery ending（ T5） were detected and compared between the two groups. Results During T3 ~ T4,the levels of MAP,HR and plasma levels of TSH,Cor in observation group were significantly lower than those in control group（ P〈0. 05）. As compared with those in T0,the levels of MAP,HR and plasma levels of TSH,Cor were significantly increased in control group（ P〈0. 05）. The serum levels of IL-1βand VAS scores on 4h,8h,24 h after operation in observation group were significantly lower than those in control group,the first analgesia time was significantly longer than that in control group,however,the analgesic dosage was significantly less than that in control group（ P〈0. 05）. Besides there were no significant differences in incidence rates of nausea and vomiting between two groups（ P〉0. 05）. Conclusion The general anesthesia endotracheal intubation combined with cervical plexus nerve block is helpful to decrease obviously the stress reaction degree and inflammatory chemokines levels of patients receiving thyroid su

关 键 词：全身麻醉 气管插管 颈丛 甲状腺 手术 

分 类 号：R614.2[医药卫生—麻醉学]