摘要
目的 探讨右美托咪啶联合全身麻醉和颈浅丛阻滞在甲状旁腺次全切除术中的麻醉效果.方法 回顾性分析2021年1月至2022年9月梧州市人民医院麻醉科63例继发性甲状旁腺功能亢进(SHPT)患者的病历资料,根据手术麻醉方法不同将患者分为观察组(右美托咪啶联合全身麻醉和颈浅丛阻滞,n=32)和对照组(全身麻醉和颈浅丛阻滞,n=31).比较两组患者围手术期的血流动力学指标[心率(HR)、舒张压(SBP)、收缩压(DBP)、平均动脉压(MAP)]、唤醒时间和Stewards评分达5分时间、麻醉药物总用量、血糖(BG)和血清去甲肾上腺素(NE)及术后不良反应的发生情况.结果 对照组患者在气管插管后、气管拔管时的HR、SBP、DBP、MAP明显高于麻醉前(均P＜0.05),而观察组在气管插管后、气管拔管时的HR、SBP、DBP、MAP与麻醉前差异无统计学意义(均P＞0.05).观察组在气管插管后、气管拔管时、离室时的HR、SBP、DBP、MAP明显低于对照组(均P＜0.05).观察组唤醒时间、Stewards评分达5分时间均显著短于对照组(均P＜0.05).观察组丙泊酚和瑞芬太尼用量明显少于对照组(均P＜0.05),两组顺式阿曲库铵的用量差异无统计学意义(P＞0.05).观察组在气管插管后、切皮时、气管拔管时、离室时的血清BG和NE水平明显低于对照组(均P＜0.05).观察组恶心、呕吐、寒战发生率均显著低于对照组(均P＜0.05).结论 右美托咪啶联合全身麻醉和颈浅丛阻滞用于SPHT患者甲状旁腺次全切除术中,有利于稳定血流动力学,抑制术中应激反应,减少术后不良反应,改善手术的全麻质量.
Abstract
Objective To explore the anesthesia effect of dexmedetomidine combined with general anesthesia and superficial cervical plexus block in subtotal parathyroidectomy.Methods A retrospective analysis was conducted on the medical records of 63 patients with secondary hyperparathyroidism(SHPT)in the anesthesia department of the People's Hospital of Wuzhou from January 2021 to September 2022.According to different surgical anesthesia methods,the patients were divided into an observation group(dexmedetomidine combined with general anesthesia and superficial cervical plexus block,n=32)and a control group(general anesthesia and superficial cervical plexus block,n=31).Two groups of patients were compared in terms of perioperative hemodynamic indicators[heart rate(HR),diastolic blood pressure(SBP),systolic blood pressure(DBP),mean arterial pressure(MAP)],wake-up time and Stewards score of 5 points,total anesthetic dosage,blood glucose(BG)and norepinephrine(NE),and incidence of postoperative adverse reactions.Results The HR,SBP,DBP,and MAP of the control group patients were significantly higher than those before anesthesia after tracheal intubation and tracheal extubation(all P＜0.05),while there was no statistically significant difference in HR,SBP,DBP,and MAP between the observation group and before anesthesia after tracheal intubation and tracheal extubation(all P＞0.05).The HR,SBP,DBP,and MAP of the observation group were significantly lower than those of the control group after tracheal intubation,during tracheal extubation,and at room departure(all P＜0.05).The wake-up time and Stewards score of 5 points in the observation group were significantly shorter than those in the control group(all P＜0.05).The dosage of propofol and remifentanil in the observation group was significantly lower than that in the control group(P＜0.05),and there was no statistically significant difference in the dosage of cisatracurium between the two groups(P＞0.05).The serum BG and NE levels in the observation group were significantly lower than those in the control group after tracheal intubation,during skin cutting,tracheal extubation,and during extubation(all P＜0.05).The incidence of nausea,vomiting,and chills in the observation group was significantly lower than that in the control group(all P＜0.05).Conclusions The combination of dexmedetomidine with general anesthesia and superficial cervical plexus block is beneficial for stabilizing hemodynamics,inhibiting intraoperative stress response,reducing postoperative adverse reactions,and improving the quality of general anesthesia in patients with subtotal parathyroidectomy.
基金项目
广西卫生健康委自筹经费科研课题(Z20211632)
NETL
NSTL
万方数据