右美托咪定复合颈丛阻滞在甲状腺手术麻醉中的应用  

Application of dexmedetomidine combined with cervical plexus block during thyroid surgery anesthesia

作　　者：韦克[1] 邓军[1] 赵兰花 李明良[1] 左朝晖[1] 刘俊福[1] 黄仕英[1] WEI Ke;DENG Jun;ZHAO Lanhua;LI Mingliang;ZUO Chaohui;LIU Junfu;HUANG Shiying(Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,China)

机构地区：[1]右江民族医学院附属医院,广西百色533000 [2]百色市妇幼保健

出　　处：《山东医药》2018年第30期31-34,共4页Shandong Medical Journal

基　　金：广西医药卫生自筹经费计划课题(Z2014608)

摘　　要：目的探讨右美托咪定(DEX)复合颈丛阻滞在甲状腺手术患者麻醉中的应用效果。方法选择择期行甲状腺手术患者100例,随机分DEX组和对照组各50例。DEX组以30μg DEX 1 m L、对照组以生理盐水1 m L分别与0.375%左布比卡因29 m L复合,均在超声引导下行双侧C4浅颈丛阻滞和单侧C3、C4深颈丛阻滞。DEX组以DEX 3μg/(kg·h)静脉持续泵注10 min后,0.2μg/(kg·h)维持静脉输注至术毕;对照组以等量生理盐水、以与DEX相同的速率持续静脉输注至术毕。于麻醉前(T0)、切皮时(T1)、甲状腺分离时(T2)、缝皮时(T3),采用Ramsay镇静评分(RSS)和视觉模拟评分(VAS)分别进行镇静、镇痛评分。采用无创血压、心电监测以及心率变异性(HRV)分析仪分别监测平均动脉压(MAP)、心率(HR)以及HRV频域参数,包括低频功率(LFP)、高频功率(HFP)、比率(LFP/HFP)、总功率(TP)。在颈丛阻滞完成后用棉签测定颈丛阻滞起效时间(CPBT)。采用患者术中配合评分(PICS)评价患者术中配合发音。结果两组T1~T3时RSS、VAS均高于T0时(P均<0.05)。DEX组T1~T3时RSS均高于对照组,VAS均低于对照组(P均<0.05)。DEX组CPBT短于对照组(P<0.01),PICS高于对照组(P<0.01)。DEX组T1~T3时HR、MAP均低于对照组(P均<0.05)。DEX组T1~T3时LFP、HFP、LFP/HFP及TP均高于对照组(P均<0.05)。结论 DEX复合颈丛阻滞能提高术中镇痛效果,提高患者术中配合发音,降低术中喉返神经损伤风险,并能维持血流动力学和HRV稳定,抑制术中应激反应,安全性较高。Objective To discuss the application effects of dexmedetomidine（ DEX） combined with cervical plexus block in thyroid surgery anesthesia. Methods One hundred patients undergoing elective thyroid surgery were randomly divided into the control group and the DEX group,with 50 cases in each. The DEX group was treated with 30 μg DEX（ 1 m L） and 0. 375% levobupivacaine（ 29 m L）,and the control group with normal saline（ 1 m L） and 0. 375% levobupivacaine（ 29 m L）. Patients in the two groups underwent ultrasound-guided bilateral C4 superficial cervical plexus block and unilateral C3 and C4 deep cervical plexus block. DEX was continuously infused at the initial speed of 3 μg/（ kg·h） for 10 min,then at the speed of 0. 2 μg/（ kg·h） until surgery end in the DEX group. Normal saline at the same velocity as DEX was continuously infused until surgery end in the control group. Sedation score and analgesia score were respectively evaluated by Ramsay sedation score（ RSS） and visual analogue scale（ VSA） before anesthesia（ T0）,at skin incision（ T1）,thyroid separation（ T2）,and sewing skin（ T3）. The mean arterial pressure（ MAP）,heart rate（ HR） and these frequency domain parameters of heart rate variability（ HRV）,including total power（ TP）,low frequency power（ LFP）,high frequency power（ HFP） and LFP/HFP,were measured and recorded by noninvasive blood pressure,electrocardiograph monitoring,and heart rate variability（ HRV） analyzer,respectively. The cervical plexus block onset effective time（ CPBT）was measured with cotton swab after cervical plexus block completion. Patients intraoperative coordination score（ PICS）was applied to evaluate the patient＇s intraoperative coordination pronounce. Results RSS and VAS in both groups at T1,T2,and T3 were higher than those at T0（ both P〈0. 05）. From T1 to T3,RSS in the DEX group was higher,and VAS was lower than that of the control group（ both P〈0. 05）. CPBT in the DEX group was shorter,and PIC

关 键 词：右美托咪定 颈丛阻滞 镇痛 镇静 心率变异性 喉返神经损伤 甲状腺手术 麻醉 

分 类 号：R614.4[医药卫生—麻醉学] R653[医药卫生—外科学]