超声引导胸横肌平面阻滞联合颈浅丛阻滞对经乳晕腔镜甲状腺切除术患者应激反应及术后疼痛的影响  

Effect of ultrasound-guided plane block of transverse pectoral muscle combined with superficial cervical plexus block on stress response and postoperative pain in patients undergoing endoscopic thyroidectomy via areola

作　　者：陈以建[1] 钟瑞蓬 黄辉民 包树臻 彭云[2] CHEN Yijian;ZHONG Ruipeng;HUANG Huimin;BAO Shuzhen;PENG Yun(Department of Anesthesia,Ganzhou People's Hospital,Jiangxi Province,Ganzhou341000,China;Department of Thyroid Surgery,Ganzhou People's Hospital,Jiangxi Province,Ganzhou341000,China)

机构地区：[1]江西省赣州市人民医院麻醉科,江西赣州341000 [2]江西省赣州市人民医院甲状腺外科,江西赣州341000

出　　处：《中国当代医药》2023年第28期104-108,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202212471);江西省赣州市科技计划项目(赣市科发[2020]60号)。

摘　　要：目的评价超声引导下胸横肌平面阻滞联合颈浅丛神经阻滞对经乳晕腔镜甲状腺切术患者应激反应及术后疼痛的影响。方法选取2022年1月至12月于赣州市人民医院行择期经乳晕腔镜甲状腺切除术的60例患者作为研究对象,采用随机数字表法将其分为观察组和对照组,每组各30例。全麻诱导后,观察组在超声引导下行双侧胸横肌平面阻滞联合双侧颈浅丛神经阻滞,对照组未进行神经阻滞操作。术后采用静脉注射布托啡诺1 mg进行补救镇痛。分别于麻醉诱导前、切皮时、术后24 h抽取外周静脉血测定各时点去甲肾上腺素(NE)、皮质醇(Cor)的含量。记录两组苏醒时间、拔除气管导管10 min后Ramsay镇静评分以及术后4、12、24 h的术后疼痛评分;记录术中瑞芬太尼消耗量,术毕至术后24 h镇痛泵有效按压次数及术后补救镇痛情况,术后24 h内不良反应的发生情况。结果两组患者的NE、Cor含量时间、组间、交互作用差异有统计学意义(P<0.05);两组患者诱导前的外周血NE、Cor含量比较,差异无统计学意义(P>0.05);观察组切皮时、术后24 h时的NE、Cor含量均低于对照组,差异有统计学意义(P<0.05);观察组患者的麻醉苏醒时间短于对照组短,观察组的拔除导管10 min后Ramsay镇静评分和镇痛药消耗量均低于对照组,差异有统计学意义(P<0.05);观察组术毕至术后24 h镇痛泵有效按压次数少于对照组,术后补救镇痛率及术后恶心呕吐发生率均低于对照组,差异有统计学意义(P<0.05)。两组均未见不良反应。结论超声引导下胸横肌平面阻滞联合颈浅丛神经阻滞能够降低经乳晕腔镜甲状腺切除术患者手术创伤应激反应,术后早期镇痛效果显著,减少阿片类药物用量,有助于患者快速康复。Objective To evaluate the effect of ultrasound-guided transverse pectoral muscle plane block combined with superficial cervical plexus block on stress response and postoperative pain in patients undergoing endoscopic thyroidectomy via areola.Methods Sixty patients who underwent elective transareolar endoscopic thyroidectomy in Ganzhou People's Hospital from January 2022 to December 2022 were selected as the study subjects and randomly divided into an observation group and a control group,with 30 patients in each group.After induction of general anesthesia,the observation group underwent bilateral transverse pectoral muscle plane block combined with bilateral superficial cervical plexus block under ultrasound guidance,while the control group did not undergo nerve block surgery.After surgery,intravenous injection of 1mg of Butorphanol was used for salvage analgesia.The contents of norepinephrine(NE)and cortisol(Cor)were measured in peripheral venous blood samples before anesthesia induction,during skin resection and 24 h after surgery.The recovery time,Ramsay sedation score 10 min after tracheal catheter removal and postoperative pain score 4,12 and 24 h after surgery were recorded in the two groups.The consumption of remifentanil during the operation,the number of effective pressure of the analgesic pump from the end of the operation to 24 h after the operation,the situation of postoperative relief and analgesia,and the occurrence of adverse reactions within 24 h after the operation were recorded.Results There were significant differences in NE and Cor content time,intergroup and interaction between the two groups(P<0.05).There was no significant difference in the contents of NE and Cor in peripheral blood between the two groups before induction(P>0.05).NE and Cor contents in observation group were lower than those in control group at incision and 24 h after operation,and the differences were statistically significant(P<0.05).The anesthesia recovery time of the observation group was shorter than that of the contro

关 键 词：胸横肌平面阻滞 颈浅丛 超声 经乳晕腔镜甲状腺切除术 应激反应 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]