超声引导下C4神经根加颈浅丛阻滞在微创甲状旁腺手术中的应用  

Ultrasound-guided Selective Cervical Nerve Root Block Plus Superficial Cervical Plexus Block for Minimally Invasive Parathyroidectomy

作　　者：李旭[1] 李敏娜[1] 崔旭蕾[1] 唐帅[1] 胡亚[2] 廖泉[2] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730

出　　处：《中国医学科学院学报》2017年第5期692-697,共6页Acta Academiae Medicinae Sinicae

基　　金：北京协和医学院创新团队发展计划~~

摘　　要：目的评估超声引导下C4神经根阻滞联合颈浅丛阻滞对微创甲状旁腺腺瘤切除术的麻醉效果。方法纳入35例甲状旁腺功能亢进、拟行微创甲状旁腺腺瘤切除手术的患者,在超声实时引导下,在C4神经根后给予0.5%罗哌卡因+1%利多卡因混合液3~4 ml,胸锁乳突肌深层给予药液5~6 ml,阻滞颈浅丛,同时复合右美托咪定输注进行镇静,阻滞后进行温度及疼痛感觉评估。结果所有患者均无须改变麻醉方式,未出现局麻药入血,无椎管内注射。6例(17.1%)患者在阻滞后出现声音嘶哑,3例(8.6%)出现Horner综合征。阻滞后10 min中位温感数字评分法评分为1.2[0,5]分,患者满意度评分平均为9.5分。结论超声引导下C4神经根加颈浅丛阻滞因阻滞目标更明确,可以较少的药量达到较好的阻滞效果,配合适度的术中镇静,可安全、有效地用于微创甲状旁腺腺瘤切除术麻醉。Objective To explore the efficacy and safety of ultrasound-guided cervical root block( CRB) in patients undergoing minimally invasive parathyroidectomy( MIP). Methods We enrolled 35 patients with hyperparathyroidism undergoing MIP in Peking Union Medical College Hospital. C4-7 nerve roots were identified in ultrasound imaging by the shape of the transverse process. A 50 mm insulated needle was gently introduced by an in-plane approach toward the posterior edge of the nerve root located at the inside of the posterior tubercle. After careful aspiration,a total of 3-4 ml of a mixture of 0. 5% ropivacaine and 1% lidocaine was slowly injected. The superficial block was administered at the midpoint of the posterior border of the sternocleidomastoid by injecting 5-6 ml of the same mixture. The patients were administrated with dexmedetomidine during the surgery. All patients were assessed for sensory following the procedure and for pain after the surgery. Results Totally 35 patients successfully received MIP under ultrasound-guided CRB plus superficial block. There was no conversion to general anesthesia,no toxic reaction of local anesthetics,and no intravertebral injection. Hoarseness occurred in6 patients( 17. 1%) and Horner syndrome occurred in 3 patients( 8. 6%). The median cold sensory visual ana-logue scale score was 1. 2 [0,5] points at 10 minutes after the procedure. Patient's satisfaction score was 9. 5 points. Conclusion Ultrasound-guided CRB plus superficial block can achieve accurate and safe anesthesia,and it provides lasting analgesic effect during and after MIP.

关 键 词：超声引导 颈神经根阻滞 甲状旁腺腺瘤切除术 

分 类 号：R614.4[医药卫生—麻醉学]