瑞芬太尼用于甲状腺手术麻醉临床观察.docVIP

瑞芬太尼用于甲状腺手术麻醉临床观察 　【关键词】 瑞芬太尼；颈丛阻滞；全身麻醉；甲状腺次全切除术 [摘要] 目的 观察瑞芬太尼在甲状腺手术中的应用效果。 方法 选择ASA(美国麻醉医师协会) 分级Ⅰ-Ⅱ级择期在颈丛复合全身麻醉下行甲状腺次全切除术病人40例，随机分为瑞芬太尼（R）组及芬太尼（F）组，R组采用瑞芬太尼和丙泊酚诱导和维持麻醉，F组采用芬太尼和丙泊酚诱导和维持麻醉，观察并比较两组病人麻醉诱导及维持期血流动力学的变化、术中丙泊酚和阿曲库铵的用量、术毕停药后病人自主呼吸恢复时间、清醒时间、拔管时间以及苏醒期不良反应等。 结果 瑞芬太尼麻醉术中循环波动较小，苏醒快，术后并发症少。 结论 与芬太尼相比，瑞芬太尼可更安全有效地用于甲状腺次全切除术。 [关键词] 瑞芬太尼；颈丛阻滞；全身麻醉；甲状腺次全切除术 [Abstract] Objective To study the clinical effect of remifentanil anesthesia in thyroidectomy. Methods Forty ASAⅠ-Ⅱpatients scheduled for elective thyroidectomy under cervical plexus block combined with general anesthesia were enrolled and randomly divided into two groups: group remifentanil (R) and group fentanyl (F). Group R were induced and maintained with remifentanil and propofol, while group F with fentanyl and propofol. Hemadynamics changing during the induction and maintenance phase, doses of propofol and atracurium, spontaneous breath recovery time, awake time, time of endotracheal tube extubation and side-effect were investigated and compared. Results There were no significant differences in doses of propofol and atracurium between two groups. Remifentanil anesthesia resulted in less circulatory disturbance, faster recovery and less post-operative complications. Conclusion Compared with fentanyl, remifentanil can be used more safely and effectively in thyroidectomy. [Key words] remifentanil；cervical plexus block；general anesthesia；thyroidectomy 由于术中牵拉挤压、体位的影响和阻滞的不完善性，单纯颈丛阻滞用于甲状腺手术常不能取得满意效果，往往需要复合全麻药或全身麻醉。瑞芬太尼是一种新型的阿片类镇痛药，具有起效快，作用时间短，恢复迅速，可控性好等优点[1]，近年来倍受人们关注。本研究尝试将瑞芬太尼全麻复合颈丛阻滞用于甲状腺次全切除术，取得良好效果，现报告如下。 1 资料与方法 1.1 一般资料 选2006年2月至6月在诸暨市人民医院择期行甲状腺次全切除术病人40例，ASAⅠ-Ⅱ级,其中男性12例，女性28例。年龄28~61岁，平均（46.78±16.82）岁，体重45~76 kg，平均（59.57±15.26）kg。其中甲状腺腺瘤11例，结节性甲状腺肿29例。所有病人术前无精神、神经疾病史，无严重肝、肾、心血管疾病，近期未服用阿片类或苯二氮卓类药物。随机分为瑞芬太尼（R）组及芬太尼（F）组，每组20例。 1.2 麻醉方法　所有病人术前30 min肌注咪唑安定0.05 mg/kg，入室后连接Datex-ohemda监护仪持续监测SBP、DBP、MAP、HR及SpO2，开放上肢静脉后行C4一针法双侧颈深丛阻滞，方法是以胸锁乳突肌后缘中点为进针点，针尖触及C4横突后，回抽无血液及脑脊液注人0.25%布比卡因10 ml，测有明确阻滞范围后诱导插管。F组诱导用