本文關(guān)鍵詞： 右美托咪定 頸叢神經(jīng)阻滯 甲狀腺手術(shù)　出處：《南昌大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的： 觀察右美托咪定聯(lián)合超聲引導下頸叢神經(jīng)阻滯在甲狀腺手術(shù)中的療效，比較該法與全身麻醉在甲狀腺手術(shù)中運用中的優(yōu)缺點，為甲狀腺手術(shù)的麻醉提供一種選擇。 方法： 擬擇期行甲狀腺病灶切除術(shù)(年齡18～65歲，男女不限，ASA分級I～II級)的患者60例，分成2組，每組30例。I組為右美托咪啶右美托咪啶聯(lián)合頸叢神經(jīng)阻滯組；II組全身麻醉組。術(shù)前訪視病人，交待術(shù)前注意事項，取得患者及家屬配合。患者入手術(shù)后，常規(guī)開放上肢靜脈，兩組患者均給予1.0ug/kg右美托咪啶泵注，10分鐘內(nèi)注射完畢，之后按0.1ug/kg/min速度持續(xù)泵注，直至手術(shù)結(jié)束。實驗組在超聲引導下行手術(shù)側(cè)頸深、頸淺叢阻滯，分別注入1%利多卡因與0.5%羅派卡因混合液各5mL，，對側(cè)行頸淺神經(jīng)阻滯，注入1%利多卡因與0.5%羅派卡因混合液5mL。手術(shù)醫(yī)生洗手、穿無菌衣，3分鐘后切皮。切皮前靜脈注射芬太尼0.05mg。記錄患者入室（泵注DEX前）（T0）、神經(jīng)阻滯前（泵注DEX后）（T1）、神經(jīng)阻滯后、（T2）、切皮后（T3）SBP、DBP、HR。對照組行靜脈麻醉誘導，靜脈推注芬太尼3-5ug/kg、丙泊酚2-2.5mg/kg、阿曲庫胺1mg/kg(2倍ED95)，行快速經(jīng)口明視下氣管插管，接麻醉機，固定氣管導管，丙泊酚4-10mg/kg/h、阿曲庫胺0.3-0.6mg/kg/h、瑞芬太尼0.2ug/kg/min麻醉維持。記錄患者入室（泵注DEX前）（T0）、全麻誘導前（泵注DEX后）（T1）、全麻誘導后、（T2）、切皮后（T3）SBP、DBP、HR。術(shù)中記錄實驗組Ramsay評分，觀察患者發(fā)聲情況，觀察患者是否出現(xiàn)不適癥狀。術(shù)后分別記錄兩組麻醉總費用，術(shù)后24小時、48小時內(nèi)對患者行術(shù)后隨訪，隨訪內(nèi)容包括兩組患者傷口引流量、術(shù)后惡心嘔吐、聲音嘶啞情況。 結(jié)果： 1、兩組病人性別構(gòu)成比、年齡、體重、ASA分級、病灶大小差異無統(tǒng)計學意義（P0.05）； 2、兩組病人T0時間點SBP、DBP、HR差異無統(tǒng)計學意義（P0.05）； 3、頸叢組病人T1、T2時間點相對T0時間點SBP、DBP、HR差異無統(tǒng)計學意義（P0.05）；T3時間點相對T2時間點SBP、DBP、HR差異無統(tǒng)計學意義（P0.05）； 4、全麻組病人T1時間點相對T0時間點SBP、DBP、HR差異無統(tǒng)計學意義（P0.05）；T2時間點相對T0時間點SBP、DBP、HR差異有統(tǒng)計學意義（P0.05）；T3時間點相對T2時間點SBP、DBP、HR差異有統(tǒng)計學意義（P0.05）； 5、頸叢組患者，術(shù)中鎮(zhèn)靜效果佳； 6、兩組病人喉返神經(jīng)損傷發(fā)生率無差異（P0.05），均為0； 7、兩組病人術(shù)后切口引流量差異無統(tǒng)計學意義（P0.05）； 8、頸叢組麻醉費用較全麻組麻醉費用低，差異有統(tǒng)計學意義（P0.05）； 9、頸叢組患者術(shù)后咽部不適感、惡心嘔吐發(fā)生率較全麻組低，差異有統(tǒng)計學意義（P0.05）； 結(jié)論： 在本試驗條件下，右美托咪定聯(lián)合超聲引導下頸叢神經(jīng)阻滯適合甲狀腺手術(shù)�；颊咴诔浞宙�(zhèn)靜的情況下，可以很好的配合術(shù)者行神經(jīng)學檢查。相對全身麻醉，該方法可使患者血流動力學更加穩(wěn)定，麻醉費用減少，節(jié)省醫(yī)療資源，術(shù)后并發(fā)癥減少。兩種麻醉方法下，喉返神經(jīng)損傷率未見差異。
[Abstract]:Objective: To observe the efficacy of dexmetomidine combined with ultrasound guided cervical plexus nerve block in thyroid surgery, and to compare the advantages and disadvantages of this method with that of general anesthesia in thyroid surgery. Provides an option for anesthesia in thyroid surgery. Methods: Sixty patients with thyroid lesion resection (18 ~ 65 years old, male and female) undergoing selective thyroidectomy were divided into two groups. 30 cases in each group were treated with dexmetidine combined with cervical plexus nerve block. Group II: general anesthesia group. Visit the patients before operation, explain the matters needing attention before operation, obtain the cooperation of the patients and their families. After the patients were operated on, the upper limb veins were routinely opened. The patients in both groups were given 1.0ug-kg dexmetidine for 10 minutes and then continued at the rate of 0.1ugP / kg / min. Until the end of the operation, the experimental group was guided by ultrasound under the operation side cervical deep, superficial cervical plexus block, respectively injected 1% lidocaine and 0.5% ropivacaine mixture of 5 mL, the opposite side of the superficial cervical nerve block. A mixture of 1% lidocaine and 0.5% ropivacaine was injected 5 mL. The surgeon washed his hands and wore a sterile coat. After 3 minutes of incision, fentanyl was injected intravenously with 0.05mg. the patients were recorded before and after DEX injection, and before nerve block (after DEX was injected with DEX), after nerve block. The control group was induced by intravenous anesthesia. Fentanyl 3-5ug-% kg and propofol 2-2.5mg / kg were injected intravenously. Atracuramide (1 mg / kg) 2 times ED95 / L, followed by rapid intubation through open vision, anaesthesia, fixation of trachea catheter, propofol 4-10 mg / kg / h. Anesthesia of atracuramide 0.3-0.6 mg / kg / h, remifentanil 0.2 ugr / kg / min was maintained. Patients were recorded in room (T0 before DEX was injected). Before the induction of general anesthesia (after DEX was injected by pump, after induction by general anesthesia, the patients were treated with T2, and the Ramsay scores of the experimental group were recorded during the operation. The total cost of anaesthesia was recorded after operation. The patients were followed up within 24 hours and 48 hours after operation. The follow-up included wound drainage, postoperative nausea and vomiting, and hoarseness. Results: 1. There was no significant difference in sex composition ratio, age, weight and ASA grade between the two groups, and there was no significant difference in lesion size between the two groups (P 0.05). (2) there was no significant difference in HR between the two groups at T0 time point (P 0.05); 3. There was no significant difference in HR between T _ 1 T _ 2 and T _ 0 time points in patients with cervical plexus. There was no significant difference in HR between T _ 3 time point and T _ 2 time point compared with that at T _ 2 time point. 4. There was no significant difference in HR between T 1 time point and T 0 time point in general anesthesia group (P 0.05). The difference of HR between T 2 time point and T 0 time point was statistically significant (P 0.05). The difference of HR between T 3 time point and T 2 time point was statistically significant (P 0.05). 5. In the cervical plexus group, the sedation effect was good during the operation. There was no difference in the incidence of recurrent laryngeal nerve injury between the two groups (P 0.05). There was no significant difference in incision drainage between the two groups (P 0.05). The cost of anesthesia in the cervical plexus group was lower than that in the general anesthesia group, and the difference was statistically significant (P 0.05). The incidence of postoperative pharynx discomfort and nausea and vomiting in the cervical plexus group was lower than that in the general anesthesia group (P 0.05). Conclusion: Under this condition, dexmetomidine combined with ultrasound guided cervical plexus nerve block is suitable for thyroid surgery. This method can make the hemodynamics of patients more stable, reduce the cost of anesthesia, save medical resources and reduce postoperative complications. There is no difference in the injury rate of recurrent laryngeal nerve between the two methods.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R653

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