【摘要】：目的:本研究通過觀察不同麻醉方法在甲狀腺癌手術(shù)中的應(yīng)用,比較不同麻醉方法對患者血流動力學(xué)、BIS、用藥量、呼吸恢復(fù)時間、蘇醒時間、拔管時間、術(shù)后疼痛及術(shù)后并發(fā)癥等方面的影響,以探究全麻聯(lián)合頸叢神經(jīng)阻滯在甲狀腺癌手術(shù)中的應(yīng)用效果,為甲狀腺癌手術(shù)的麻醉提供一種好的選擇。方法:選擇60例需行甲狀腺癌手術(shù)的患者分為觀察組和對照組,每組30例。兩組患者手術(shù)前半小時采用0.5mg阿托品與0.1g魯米那鈉進(jìn)行肌注。對照組患者采用全麻,觀察組患者采用超聲引導(dǎo)下頸叢神經(jīng)阻滯聯(lián)合全麻。頸叢神經(jīng)阻滯選用一針法,用1%利多卡因和0.375%羅哌卡因混合液作為局麻藥物,穿刺在超聲引導(dǎo)下進(jìn)行,于患者的患側(cè)頸深叢與頸淺叢分別注射8ml、4ml的藥物,健側(cè)頸淺叢用4ml局麻藥物注射,阻滯后10min利用針刺法進(jìn)行阻滯效果測試。阻滯完善后,及時麻醉誘導(dǎo)進(jìn)行氣管插管,誘導(dǎo)藥物依次是咪達(dá)唑侖、舒芬太尼、丙泊酚、順式阿曲庫銨,以劑量分別為0.04-0.06mg/kg、0.4-0.6 ug/kg、2.0-2.5 mg/kg、0.15-0.2 mg/kg靜注,在直視的情況下氣管插管。兩組患者的全麻維持都采用丙泊酚與維庫溴銨持續(xù)泵入進(jìn)行,手術(shù)結(jié)束待患者清醒后將氣管導(dǎo)管拔除。分別記錄所有患者手術(shù)全程中心率、血壓、BIS、呼吸恢復(fù)時間、蘇醒時間及拔管時間、麻醉藥物用量以及術(shù)后4小時VAS評分。對比觀察兩種麻醉方式在患者(1)心率、血壓、BIS值的變化;(2)麻醉藥物的用量;(3)呼吸恢復(fù)時間、蘇醒時間以及氣管導(dǎo)管拔除時間;(4)術(shù)后4h VAS評分及術(shù)后并發(fā)癥方面是否存在差異。采用a=0.05的檢驗水準(zhǔn),應(yīng)用SPSS統(tǒng)計軟件包進(jìn)行分析。結(jié)果:觀察組與對照組相比較,HR、SBP、DBP更穩(wěn)定,存在統(tǒng)計學(xué)差異(P0.05);觀察組患者BIS值波動與收縮壓波動小于對照組,存在統(tǒng)計學(xué)差異(P0.05),但兩組患者舒張壓波動與HR波動不存在統(tǒng)計學(xué)差異(P0.05);觀察組患者呼吸恢復(fù)時間、蘇醒時間及拔管時間顯著早于對照組(P0.01);觀察組患者全麻藥物的用量少于對照組,存在統(tǒng)計學(xué)顯著性差異(P0.05);與對照組患者相比,觀察組患者的術(shù)后4h VAS評分降低(P0.05),術(shù)后并發(fā)癥中的咽喉不適和惡心嘔吐發(fā)生率明顯減少(P0.05)。結(jié)論:甲狀腺癌手術(shù)的麻醉中,全麻聯(lián)合頸叢神經(jīng)阻滯對患者血流動力學(xué)影響小,術(shù)中對患者造成的應(yīng)激反應(yīng)小,機(jī)體各項指標(biāo)平穩(wěn),波動幅度較小,蘇醒快,拔管早,術(shù)后疼痛較輕,術(shù)后并發(fā)癥較少,有利于患者術(shù)后恢復(fù)。
[Abstract]:Objective: to observe the application of different anesthetic methods in thyroid cancer surgery, and to compare the effects of different anesthetic methods on the hemodynamics of patients with BIS, the dosage of drugs, the time of respiratory recovery, the time of extubation. In order to explore the effect of general anesthesia combined with cervical plexus nerve block in the operation of thyroid cancer, the effect of postoperative pain and postoperative complications was discussed, which provided a good choice for the operation of thyroid cancer. Methods: 60 patients with thyroid carcinoma were divided into observation group and control group with 30 cases in each group. Patients in both groups were given intramuscular injection of 0.5mg atropine and 0.1 g roumina sodium half an hour before operation. The patients in the control group were treated with general anesthesia, and the patients in the observation group were treated with cervical plexus nerve block combined with general anesthesia under the guidance of ultrasound. The cervical plexus nerve block was performed with 1% lidocaine and 0.375% ropivacaine as local anesthetic. The puncture was conducted under the guidance of ultrasound. The patients were injected with 8ml of 4 ml of drug in the deep cervical plexus and superficial cervical plexus, respectively. The contralateral superficial cervical plexus was injected with 4ml local anesthetic, and the effect of 10min was tested by acupuncture after block. After the block was completed, tracheal intubation was induced in time. Midazolam, sufentanil, propofol, cis-atracurium were given intravenously at doses of 0.04-0.06 mg / kg 0.4-0.6 mg 路kg ~ (-1) 路kg ~ (-1) -2.0-2.5 mg / kg 路kg ~ (-1) 0.15-0.2 mg/kg respectively. Propofol and vecuronium were used to maintain general anesthesia in both groups. Tracheal catheter was removed after operation. The central rate, blood pressure, respiratory recovery time, recovery time and extubation time, anesthetic dosage and VAS score were recorded in all patients. The changes of heart rate, blood pressure and BIS were compared between the two anesthesia methods. (2) the dosage of anesthetic drugs; (3) respiratory recovery time, recovery time and tracheal catheter extubation time; (4) whether there were differences in VAS scores and postoperative complications at 4 hours after operation. The test level of A0. 05 was used and the analysis was carried out by SPSS statistical software package. Results: compared with the control group, the observation group was more stable than the control group (P0.05), the fluctuation of BIS and systolic blood pressure in the observation group was smaller than that in the control group. There was statistical difference (P0.05), but there was no significant difference between the two groups in diastolic blood pressure fluctuation and HR fluctuation (P0.05). The recovery time and extubation time were significantly earlier than that of the control group (P0.01); the dosage of general anesthesia in the observation group was less than that in the control group, there was significant difference (P0.05); compared with the control group, In the observation group, the VAS score decreased at 4 hours after operation (P0.05), and the incidence of pharyngolaryngeal discomfort and nausea and vomiting in postoperative complications decreased significantly (P0.05). Conclusion: general anesthesia combined with cervical plexus block has little effect on hemodynamics in patients with thyroid carcinoma. The stress response to patients during operation is small, the body indexes are stable, the fluctuation is small, the recovery is fast, and the extubation is early. Postoperative pain is less and postoperative complications are less, which is beneficial to postoperative recovery.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614;R736.1

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