超声引导下罗哌卡因颈神经通路阻滞应用于甲状腺良性结节射频消融的半数有效浓度  

Median Effective Concentration of Ultrasound-guided Cervical Nerve Block with Ropivacaine for Radiofrequency Ablation of Benign Thyroid Nodules

作　　者：银丽[1] 彭俊[2] 沈翔[3] 杨得琳 秦旭[3] 罗玲[3] 何明清[1] YIN Li;PENG Jun;SHEN Xiang;YANG Delin;QIN Xu;LUO Ling;HE Mingqing(Department of Ultrasound No.1 People's Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,Sichuan,China;Department of Obstetrics and Gynecology No.1 People's Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,Sichuan,China;Department of Anaesthesia No.1 People's Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,Sichuan,China;Departmentof Thyroid and breast surgery No.1 People's Hospital of Liangshan Yi Autonomous Prefecture,Xichang 615000,Sichuan,China)

机构地区：[1]凉山彝族自治州第一人民医院超声科,四川西昌615000 [2]凉山彝族自治州第一人民医院妇产科,四川西昌615000 [3]凉山彝族自治州第一人民医院麻醉科,四川西昌615000 [4]凉山彝族自治州第一人民医院甲乳外科,四川西昌615000

出　　处：《医学信息》2025年第4期102-106,111,共6页Journal of Medical Information

基　　金：凉山州科技计划项目(编号:22ZDYF0083);凉山州学术和技术带头人培养资金资助项目(编号:凉人社办发〔2023〕5号)。

摘　　要：目的探讨超声引导下罗哌卡因颈神经通路阻滞麻醉应用于甲状腺良性结节射频消融治疗的半数有效浓度。方法纳入2022年6月-2023年9月凉山彝族自治州第一人民医院择期甲状腺良性结节射频消融治疗患者共36例,采用序贯法确定罗哌卡因半数有效浓度,罗哌卡因容量设定为10 ml,0.375%为初始浓度,如阻滞效果良好,则下一例患者采用低一级浓度,反之则采用高一级浓度,相邻两级浓度之比为1∶1.2。观察患者消融前(T0)、消融过程中(T1)的心率(HR)、平均动脉压(MAP);观察消融中(T1)及消融后1 h(T2)、4 h(T3)、8 h(T4)、12 h(T5)患者VAS评分;记录T0~T5患者血清中神经肽(NPY)、前列腺素E2(PGE2)水平;观察患者消融不良反应情况。结果其中18例在颈神经通路阻滞良好,顺利完成手术超声引导下甲状腺良性结节射频消融术,18例阻滞效果差、改用其它麻醉方式完成手术。罗哌卡因颈神经通路阻滞EC50为0.419%(95%CI:0.373%~0.469%)。阻滞效果良好患者中罗哌卡因浓度为0.375%、0.450%组T1的HR、MAP较T0升高,差异有统计学意义(P<0.05);阻滞起效时间随罗哌卡因浓度的增加而减低,各浓度组T1~T5的VAS评分比较,差异有统计学意义(P<0.05);不同浓度罗哌卡因组于T0~T5的NPY及PGE2浓度比较,差异有统计学意义(P<0.05);消融不良反应:恶心1例(2.78%),声音嘶哑2例(5.56%),均于消融后4 h恢复。结论超声引导下罗哌卡因颈神经通路阻滞应用于甲状腺良性结节射频消融的EC50为0.419%,容量为10 ml,可提供安全有效的术中麻醉及围术期镇痛,值得临床应用。Objective To investigate the median effective concentration of ultrasound-guided ropivacaine cervical nerve pathway block anesthesia for radiofrequency ablation of benign thyroid nodules.Methods From June 2022 to September 2023,a total of 36 patients undergoing elective radiofrequency ablation of benign thyroid nodules in the No.1 People's Hospital of Liangshan Yi Autonomous Prefecture were enrolled.The median effective concentration of ropivacaine was determined by sequential method.The volume of ropivacaine was set to 10 ml,and 0.375%was the initial concentration.If the block effect was good,the next patient was treated with a lower level of concentration.Otherwise,a higher level of concentration was used,and the ratio of adjacent two levels of concentration was 1∶1.2.The heart rate(HR)and mean arterial pressure(MAP)were observed before ablation(T0)and during ablation(T1).The VAS score of patients during ablation(T1)and at 1 h(T2),4 h(T3),8 h(T4)and 12 h(T5)after ablation was observed.The serum levels of neuropeptide(NPY)and prostaglandin E2(PGE2)in patients with T0-T5 were recorded.The adverse reactions of ablation were observed.Results Among them,18 patients had good cervical nerve pathway block and successfully completed ultrasound-guided radiofrequency ablation of benign thyroid nodules.18 patients had poor block effect and were converted to other anesthesia methods to complete the operation.The EC50 of ropivacaine for cervical nerve pathway block was 0.419%(95%CI:0.373-0.469).In the patients with good block effect,the HR and MAP of the ropivacaine concentration of 0.375%and 0.450%groups at T1 were higher than those at T0,and the difference were statistically significant(P<0.05).The onset time of block decreased with the increase of ropivacaine concentration,and the VAS score of T1-T5 in each concentration group was significantly different(P<0.05).There were significant differences in the concentrations of NPY and PGE2 at T0-T5 in different concentrations of ropivacaine groups(P<0.05).Adverse reactions of

关 键 词：甲状腺 射频消融 罗哌卡因 半数有效浓度 

分 类 号：R581[医药卫生—内分泌]