含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用

摘要

目的：探讨含盐酸罗哌卡因的膨胀液对腔镜下甲状腺手术患者术后镇痛、镇静、血流动力学和不良反应等影响，阐明其临床应用的有效性和安全性。方法：择期行经胸乳路腔镜下甲状腺手术患者40例，根据使用膨胀液不同随机分为生理盐水组和含盐酸罗哌卡因膨胀液组（罗哌卡因组），每组20例。记录2组患者术前麻醉访视时（T0）、注射膨胀液前（T1）、手术结束时（T2）和气管导管拔除时（T3）的平均动脉压（MAP）和心率（HR），以及术中出血量、手术时间、术后引流量、住院天数和术后24 h 内恶心呕吐、呼吸抑制和局麻药毒性反应及术后切口感染、喉返神经损伤等不良反应。观察拔除气管导管后即刻（T3）、0.5 h （T4）、2 h （T5）、6 h （T6）、12 h （T7）和24 h （T8）各时间点患者的疼痛视觉模拟评分法（VAS）评分及 T3和 T4时间点的Ramsay 镇静评分。结果：2组患者 T0和 T1时间点 MAP 和 HR 比较差异无统计学意义（P ＞0.05）；与生理盐水组比较，罗哌卡因组患者 MAP 和 HR 在 T2和 T3时间点均明显降低（P ＜0.05）。2组患者手术时间、术中出血量、术后引流量和住院天数比较差异均有统计学意义（P ＜0.05）。与生理盐水组比较，罗哌卡因组患者术后24 h 追加镇痛药和恶心呕吐发生例数明显减少（P ＜0.05）。与生理盐水组比较，罗哌卡因组患者在 T3、T4、T5、T6、T7和 T8各时间点的 VAS 评分和 T3、T4时间点的 Ramsay 镇静评分均明显降低（P ＜0.05）。结论：含盐酸罗哌卡因的膨胀液可有效降低腔镜甲状腺手术期间的应激反应，并可提供良好的术后镇痛，减少手术引起的创伤。%Objective:To study the effects of expansion of ropivacaine hydrochloride liquid on the postoperative analgesia,sedation, hemodynamic effects and adverse drug reactions of the patients underwent endoscopic thyroidectomy,and to explore its clinical effectiveness and safety. Methods:Forty patients who were to undergo endoscopic thyroidectomy via chest-breast approach were randomly assigned to saline solution group and expansion liquid of ropivacine hydrochloride group (ropivacaine group,n = 20).The mean arterial pressure (MAP )and heart rate (HR)were also evaluated at the following time points:preoperative evaluation (T0 ),before local anesthetic infiltration (T1 ),at the end of the operation (T2 );the blood loss,the operation time,the postoperative drainage,and the hospital duration of the patients in two groups were recorded; the nausea and vomiting,the respiratory depression,the toxicity response,the infection,and the recurrent laryngeal nerve injury during 24 h after operation were recorded.The postoperative pain scores were assessed at extubaltion (T3 ),30 min (T4 ),2 h (T5 ),6 h (T6 ),12 h (T7 )and 24 h (T8 )after extubation using Visual Analog Scale (VAS).The postoperative Ramsay scores were assessed at T3 and T4 .Results:There were no significant differences in MAP and HR at T0 and T1 of the patients between two groups (P >0.05).Compared with saline solution group,the MAP and HR at T2 and T3 of the patients in ropivacaine group were significantly decreased (P < 0.05).There were significant differences in the blood loss,the operation time, the postoperative drainage,and the hospital duration of the patients between two groups (P <0.05).The number of patients required postoperative analgesia and the number patients with nausea and vomiting in ropivacaine group were decreased compared with saline solution group (P <0.05).Compared with saline group,the VAS scores at T3 ,T4 ,T5 ,T6 ,T7 and T8 of the patients in ropivacaine group were significantly decreased (P <0.05);the Ramsay scores at T3 and T4 of the patients in ropivacaine group were also decreased significantly (P <0.05).Conclusion:Expansion liquid of ropivacaine hydrochloride can reduce the stress response during endoscopic thyroidectomy effectively and reduce the postoperative pain and injury induced by operation.