颈丛神经阻滞麻醉联合全身麻醉对甲状腺功能亢进症患者甲状腺次全切除术效果及应激反应影响  

Effects of cervical plexus block anesthesia combined with general anesthesia on subtotal thyroidectomy in patients with hyperthyroidism and stress response

作　　者：钟国云 钱敏 周汉辉 Zhong Guoyun;Qian Min;Zhou Hanhui(Department of Anesthesiology,Zhangjiagang City Hospital of Traditional Chinese Medicine,Jiangsu Province,Suzhou 215600,China)

机构地区：[1]江苏省张家港市中医医院麻醉科,苏州215600

出　　处：《中华地方病学杂志》2022年第12期999-1003,共5页Chinese Journal of Endemiology

摘　　要：目的探讨颈丛神经阻滞麻醉联合全身麻醉对甲状腺功能亢进症(甲亢)患者甲状腺次全切除术效果及应激反应影响。方法选择江苏省张家港市中医医院于2018年1月至2021年1月行甲状腺次全切除术的甲亢患者68例作为观察对象,按随机数字表法分为对照组与观察组,每组34例。对照组采用全身麻醉,观察组采用颈丛神经阻滞麻醉联合全身麻醉。比较2组患者麻醉前(T0)、插管前即刻(T1)、插管后即刻(T2)、手术结束时(T3)心率和平均动脉压,术后苏醒时间和拔管时间,术后1、4、12、24 h疼痛视觉模拟评分(VAS),术前和术后24 h应激反应,术后并发症等。结果2组患者T0时刻心率和平均动脉压比较,差异均无统计学意义(P均>0.05);T1时刻心率和平均动脉压均较同组T0时刻低(P均<0.05);对照组T2、T3时刻心率和平均动脉压均较同组T0时刻高(P均<0.05);观察组T2、T3时刻心率和平均动脉压与同组T0时刻比较,差异均无统计学意义(P均>0.05),但均低于同时间对照组(P均<0.05)。观察组患者苏醒时间和拔管时间均短于对照组(P均<0.001)。观察组患者术后4、12、24 h VAS均低于对照组(P均<0.001)。2组患者术后24 h血清去甲肾上腺素(NE)和皮质醇(COR)水平均高于同组术前,且观察组均低于同时间对照组(P均<0.05)。观察组患者术后并发症总发生率(8.82%,3/34)低于对照组(29.41%,10/34,χ^(2)=4.66,P=0.031)。结论颈丛神经阻滞麻醉联合全身麻醉对甲亢患者甲状腺次全切除术效果良好,可加快患者苏醒,减少并发症发生,且应激反应程度较轻。Objective To investigate the effects of cervical plexus block anesthesia combined with general anesthesia on subtotal thyroidectomy in patients with hyperthyroidism and stress response.Methods A total of 68 patients with hyperthyroidism who underwent subtotal thyroidectomy in Zhangjiagang City Hospital of Traditional Chinese Medicine,Jiangsu Province,from January 2018 to January 2021 were selected as observation subjects,and were divided into control group and observation group according to the random number table method,both of which were 34 cases.Patients in control group were given general anesthesia,and the observation group was given cervical plexus block anesthesia combined with general anesthesia.The heart rate and mean arterial pressure before anesthesia(T0),immediately before intubation(T1),immediately after intubation(T2),and at the end of surgery(T3),the time of awakening and extubation after surgery,the visual analog score(VAS)of pain at 1,4,12,and 24 hours after surgery,stress response of before and 24 hours after surgery,and complications after surgery were compared between the two groups.Results There was no significant difference in heart rate and mean arterial pressure between the two groups at T0(P>0.05);the heart rate and mean arterial pressure at T1 were lower than those at T0 in the same group(P<0.05);the heart rate and mean arterial pressure at T2 and T3 in the control group were higher than those at T0 in the same group(P<0.05);the heart rate and mean arterial pressure at T2 and T3 in the observation group did not change significantly compared with those at T0 in the same group(P>0.05),but were lower than those in the control group at the same time(P<0.05).The awakening time and extubation time of patients in the observation group were shorter than those in the control group(P<0.001).The VAS scores of patients in the observation group were lower than those in the control group at 4,12 and 24 hours after surgery(P<0.001).The serum norepinephrine(NE)and cortisol(COR)levels of patients in the

关 键 词：甲状腺功能亢进症 甲状腺次全切除术 颈丛神经阻滞麻醉 效果 安全性 

分 类 号：R614[医药卫生—麻醉学]