喉罩通气全麻联合颈丛神经阻滞在甲状腺手术中的应用

摘要

Objective To evaluate the efficacy of laryngeal mask anesthesia (LMA) combined with cervical plexus block for thyroid surgery. Methods Seventy five ASAⅠ-Ⅱpatients, aged 18 to 65, weighing from 50 to 75 kg, who were undergoing thyroid surgery, were randomly divided into 3 groups:Group A, Group B and Group C ( n=25). Group A was given LMA combined with cervical plexus block, Group B received LMA on-ly, Group C received endotracheal intubation (ETT) only. The heart rate, mean artery pressure were recorded in three groups before anesthesia, at ETT/LMA insertion, at 30 min of operation, at ETT/LMA removed in-stantly, and at 20 min ETT/ LMA removed. The dosage of propofol and remifentanil were recorded. The scores of Observer Assessment of Sedation (OAA/S) at 20 min after ETT/ LMA removed and the scores of pain visual analog scale (VAS) at 3, 5 h after operation were recorded. The operation time, awakening time and the incidences of post operative nausea vomiting, dysphoria and pharyngalgia were also recorded. Results Group A, B showed hemodynamic stability in perioperation time, but in Group C, mean artery pres-sure and heart rate were significantly higher in perioperation time (P<0.05). Compared with Group C, Group A, B showed shorter awaking time (P<0.05), lower incidence of post operative nausea vomiting (P<0.05) and prolonged postoperative analgesia (P<0.05). The scores of OAA/S at 20 min after ETT/LMA removed in Group A, B were lower than in Group C (P<0.05). Conclusions LMA combined with cervical plexus block and LMA only are safe and effective for thyroid surgery, with fewer complications, but combined group has satisfactory postoperative analgesic effect. These two methods of anesthesia can be appliced to the opera-tion of thyroid.%目的：探讨喉罩通气全麻联合颈丛神经阻滞在甲状腺手术中的应用。方法75例甲状腺手术患者随机分为喉罩全麻联合颈丛神经阻滞组（A组）、单纯喉罩全麻组（B组）和单纯气管插管全麻组（C组），分别观察所有患者诱导前（T0）、喉罩（或气管插管）置入即刻（T1）、手术30 min （T2）、喉罩（或插管）拔除即刻（T3）、喉罩（或插管）拔除20 min （T4）患者心率、平均动脉压的变化；记录各组静脉麻醉药丙泊酚和瑞芬太尼的用量；记录手术时间、苏醒时间，苏醒期呛咳、躁动、恶心呕吐和术后咽喉痛的发生例数；喉罩（或插管）拔除20 min进行警觉与镇静评分、术后3、5h进行视觉模拟疼痛评分。结果 A、B组血流动力学稳定，围术期心率和平均动脉压的差异无统计学意义（P>0.05）；C组围术期血流动力学变化剧烈，A、B组分别与C组相比，差异有统计学意义（P<0.05）。A、B组患者苏醒时间短于C组（P<0.05），苏醒期呛咳、躁动，恶心呕吐和术后咽喉痛的发生例数少于C组（P<0.05）；喉罩（或插管）拔除20 min警觉与镇静评分低于C组（P<0.05），A组术后3、5 h疼痛评分低于B、C组（P<0.05）；A、B组瑞芬太尼和丙泊酚的用量少于C组（P<0.05）。结论喉罩通气全麻联合颈丛神经阻滞和单纯喉罩全麻都能很好的满足甲状腺手术的麻醉要求，围术期血流动力学稳定、镇痛完善，麻醉效果佳；苏醒快，苏醒期呛咳、躁动等不良反应少，苏醒质量高；术后咽喉痛、恶心呕吐等并发症的发生少，只是联合组有持久稳定的术后镇痛作用，这两种麻醉方法均可在甲状腺手术中应用。