本文選題：超聲 + 頸叢神經(jīng)阻滯　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)全麻復(fù)合超聲引導(dǎo)雙側(cè)頸淺叢阻滯在甲狀腺切除術(shù)中的應(yīng)用效果。方法:擇期甲狀腺切除女性患者120例,ASA分級(jí)I-II級(jí),年齡20-70歲,體重45-85kg。行全身麻醉誘導(dǎo):依次靜脈推注咪達(dá)唑侖0.03mg/kg、丙泊酚2mg/kg、舒芬太尼0.5ug/kg、維庫(kù)溴銨0.05mg/kg,各組待睫毛反射消失后,可視喉鏡插入喉返神經(jīng)監(jiān)測(cè)專(zhuān)用氣管導(dǎo)管,行機(jī)械通氣,吸入地氟醚維持麻醉。納入患者隨機(jī)分為四組,A組(n=30)行單純?nèi)?術(shù)后使用PCIA泵,B(n=30)組單純?nèi)?術(shù)后無(wú)PCIA泵,C組(n=30)、D組(n=30)于全麻后,經(jīng)超聲引導(dǎo)用0.33%羅哌卡因14ml行雙側(cè)頸淺叢阻滯(Bilateral superficial cervical plexus block,BSCPB),術(shù)后分別使用、未用PCIA進(jìn)行鎮(zhèn)痛。記錄術(shù)中鎮(zhèn)痛藥物用量、術(shù)后48h疼痛、惡心嘔吐(PONV)VAS評(píng)分及術(shù)后24h進(jìn)食、排氣、排便及床旁活動(dòng)時(shí)間,基礎(chǔ)值(麻醉前5min)、T1(插管后5min)、T2(開(kāi)皮后10min)、T3(手術(shù)結(jié)束)、T4(拔管時(shí))SBP、DBP、MAP、HR等指標(biāo)數(shù)值。結(jié)果:A、B組在T1、T2、T3、T4的SBP、DBP、MBP、HR均較基礎(chǔ)值明顯升高(P0.05),C、D組在T1、T2、T3的SBP、DBP、MBP、HR均較基礎(chǔ)值輕度升高(P0.05),在T4時(shí)刻較基礎(chǔ)值顯著升高(P0.05),兩組間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),A、B兩組與C、D兩組間在T1、T2、T3時(shí)刻比較有顯著差異(P0.05)。C、D兩組術(shù)后疼痛VAS評(píng)分、術(shù)中舒芬太尼用量顯著低于A、B組(P0.05),且B組術(shù)后VAS評(píng)分高于A組(P0.05),C、D兩組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。A、B、C三組術(shù)后惡心嘔吐評(píng)分顯著高于D組,A、B組術(shù)后惡心嘔吐程度更重(P0.05),B組術(shù)后惡心嘔吐最為嚴(yán)重(P0.05)。A、B兩組較C、D兩組術(shù)后床旁活動(dòng)所需時(shí)間長(zhǎng)(P0.05),且A組床旁活動(dòng)所需時(shí)間更長(zhǎng)(P0.05)。C、D組在24小時(shí)內(nèi)排氣、排便例數(shù)顯著高于A、B組(P0.05),且二者間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:全麻復(fù)合超聲引導(dǎo)雙側(cè)頸淺叢阻滯較單純?nèi)樾g(shù)中、術(shù)后鎮(zhèn)痛和止吐效果更好,有利于維持術(shù)中循環(huán)穩(wěn)定,降低術(shù)后并發(fā)癥發(fā)生率,加快患者術(shù)后恢復(fù)。
[Abstract]:Objective: to evaluate the effect of combined general anesthesia and ultrasound guided bilateral superficial cervical plexus block in thyroidectomy. Methods: a total of 120 female patients with selective thyroidectomy were enrolled in this study. Their age was 20-70 years old and their weight was 45-85 kg. General anesthesia induction: intravenous injection of midazolam 0.03 mg / kg, propofol 2 mg / kg, sufentanil 0.5 mg / kg, vecuronium 0.05 mg / kg. After eyelash reflex disappeared, visual laryngoscope was inserted into a special tracheal tube for recurrent laryngeal nerve monitoring, and mechanical ventilation was performed. Inhalation of desflurane maintained anesthesia. The patients were randomly divided into four groups: group A (n = 30) received simple general anesthesia, group C (without PCIA pump C) and group D (n ~ (30) were treated with general anesthesia after general anesthesia. Bilateral superficial cervical plexus block with bilateral superficial cervical plexus block was performed with 0.33% ropivacaine 14ml under ultrasound guidance. No PCIA was used for analgesia. The dosage of analgesic during operation, pain 48 hours after operation, nausea and vomiting PONVVAS score, feeding, venting, defecation and bedside activity time at 24 hours after operation, basic value (5 min before anesthesia and T1 (5 min after intubation and T2 (10 min after extubation) (mitogen HR at extubation) were recorded. Results in T1 / T2T3 / T1 / T2 / T3 / T4 / T1 / T2 / T3 / T4 / T1 / T2 / T3 / T4 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T3 / T1 / T2T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / T4 / There was significant difference in VAS score of postoperative pain between the two groups. The dosage of sufentanil in group A was significantly lower than that in group A (P 0.05), and the postoperative VAS score in group B was higher than that in group A (P 0.05). The duration of bedside activity in group A was longer than that in group C and D, and the time required for bedside activity in group A was longer than that in group C (P 0.05). The number of defecation cases in group A was significantly higher than that in group A (P 0.05), and there was no statistical difference between the two groups (P 0.05). Conclusion: general anesthesia combined with ultrasound guided bilateral superficial cervical plexus block has better analgesic and antiemetic effects than that of simple general anesthesia, which is beneficial to maintain the stability of circulation during operation, reduce the incidence of postoperative complications, and accelerate the postoperative recovery.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R614

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