右美托咪定联合颈浅丛阻滞在继发甲状旁腺功能亢进行甲状旁腺全切除加自体前臂移植术患者患者中的应用  

Application of Dexmedetomidine Combined with Superficial Cervical Plexus Block in the Total Parathyroidectomy with Forearm Autograft in Patients with Secondary Hyperparathyroidism

作　　者：王昌松[1] 张悦 任静华[1] 姚洪林[1] 何常佑 屈晓玲[1] 

机构地区：[1]宜宾市第二人民医院麻醉科,四川宜宾644000

出　　处：《四川医学》2017年第12期1424-1427,共4页Sichuan Medical Journal

摘　　要：目的比较单纯气管插管全麻与气管插管全麻联合右美托咪定和颈浅丛阻滞在慢性肾功能衰竭继发甲状旁腺功能亢进(SHPT)患者行甲状旁腺全切除加自体前臂皮下移植术(TPTX+AT)中的优、缺点。方法选择80例择期行TPTX+AT术的慢性肾功能衰竭SHPT患者,随机分为全麻组(G1)组、全麻联合颈浅丛组(G2)组、全麻联合右美托咪定组(D1)组、全麻联合右美托咪定和颈浅丛组(D2)组,每组20例。四组全麻诱导和维持选择同样的方法和药物。观察四组患者围术期血流动力学参数和去甲肾上腺素(NE)水平变化,麻醉药总用量和术后恶心、呕吐、寒颤、呼吸抑制的发生情况。结果 D2组围术期生命体征更平稳,NE水平更低,全麻药用量最少,术后恶心、呕吐、寒颤、呼吸抑制发生率最低,差异有统计学意义(P<0.05)。结论右美托咪定联合颈浅丛阻滞可以明显抑制术中应激反应,减少术后并发症的发生,改善SPHT患者手术的全麻质量。Objective To compare the merits and faults between single general anesthesia with tracheal intubation and general anesthesia plussuperficial cervical plexus block for the total parathyroidectomy with forearm autograft（ TPTX ＋ AT）in pa- tients with chronic renal failure and secondary hyperparathyroidism （SHPT）. Methods A total of 80 patients with chronic renal failure and SHPT were randomly divided into four groups （n = 20） ：general anesthesia（ G1 group）, general anesthesia plus superfi- cial cervical plexus block（ G2 group）, general anesthesia plus dexmedetomidine（ D1 group）and general anesthesia plus dexmedeto- midine combined with superficial cervical plexus block（ D2 group）. Methods and drp.gs used for induction and maintenance of general anesthesia in all groups were the same. The perioperative hemodynamic parameters and changes of norepinephrine （NE）lev- els were monitored. The cumulative usage of general anesthetics and the incidences of nausea, vomiting, chills and respiratory de- pression after operation were observed. Results D2 group had more stable vital signs during the perioperative period,lower level of NE, the least usage of general anesthetics and the lowest incidence of nausea, vomiting, chills and respiratory depression after opera- tion（P 〈 0. 05）. Conclusion Dexmedetomidine combined with superficial cervical plexus block can remarkably inhibit operation stress, reduce the incidence of postoperative complications and improve the general anesthesia quality of operation in patients with SHPT.

关 键 词：右美托咪定 全身麻醉 继发性甲状旁腺功能亢进 甲状旁腺切除术 自体移植 

分 类 号：R614[医药卫生—麻醉学]