【摘要】 目的通过观察小剂量吗啡-罗哌卡因颈丛神经阻滞复合静脉全麻应用于腔镜辅助甲状腺手术中的麻醉及术后镇痛效果,探寻一种比较适用于该种术式的麻醉方法。方法选择行腔镜辅助甲状腺手术的患者96例,随机均分为三组:全凭静脉全麻组(A组)、罗哌卡因颈丛神经阻滞复合静脉全麻组(B组)及小剂量吗啡-罗哌卡因颈丛神经阻滞复合静脉全麻组(C组)。B、C两组分别先以0.25%罗哌卡因及0.25%罗哌卡因与吗啡4mg混合液25mL行双侧颈丛神经阻滞;A组给予等量生理盐水对照,15min后行全麻,观察并记录三组患者术中芬太尼等的用药量、睁眼时间、拔管时间、术中知晓发生率及术后镇痛持续时间,并进行术后镇痛VAS评分。结果芬太尼用药量B、C两组明显少于A组(P<0.05);睁眼时间及拔管时间B、C两组明显短于A组(P<0.05);术后6～24 h内VAS评分显著低于A组(P<0.01或0.05),而术后14～48 h内VAS评分C组显著低于A、B两组(P<0.01或0.05);术后镇痛持续时间C组明显长于A、B两组(P<0.01或0.05)。三组均无术中知晓发生。结论小剂量吗啡-罗哌卡因颈丛神经阻滞复合静脉全麻是一种更适合应用于腔镜辅助甲状腺手术、操作相对简便、副作用较少且可产生良好的术后镇痛效果的麻醉方法。更多还原

【Abstract】 [Objective]To observe the small dose of morphine-ropivacaine Cervical plexus block combined with intravenous anesthesia used in assisted endoscopic thyroid surgery anesthesia and postoperative analgesia,to explore a method of anesthesia more suitable for this type of surgical.[Methods]96 patients scheduled for endoscopic thyroid surgery were randomly and averagely divided into three groups:total intravenous anesthesia group(group A), ropivacaine cervical plexus block combined with intravenous anesthesia group(group B) and small dose of morphine -ropivacaine cervical plexus block combined intravenous anesthesia group(group C).Group B,C were given separately 25ml ropivacaine 0.25%and 0.25%ropivacaine and mixture of morphine 4 mg underwent bilateral cervical plexus block;and simulation group A was given normal equal saline,after 15 minutes general anesthesia was carried out.Intraoperative fentanyl dosage,the time from completion of anesthesia to eye opening and tracheal extubation, the incidence of intraoperative awareness,duration of postoperative analgesia and VAS scores for postoperative pain relief were recorded in three groups.No intraoperative awareness was found in three groups.[Results] Fentanyl dosage of group B,C was significandy less than group A(P<0.05);anesthesia recovery time and the time of tracheal extubation of group B,C were significandy shorter than group A(P<0.05 );VAS score within 6～24 h postoperative was significantly lower than A group(P<0.01 or 0.05),but within 14～48 h postoperative VAS score in group C was significantly lower than group A,B(P<0.01 or 0.05 );postoperative analgesia of group C was significantly longer than the duration of group A,B(P<0.01 or 0.05 ).[Conclusion]Low dose of morphine-ropivacaine cervical plexus block combined with intravenous anesthesia is more suitable for laparoscopic assisted thyroid surgery, the operation is relatively simple,with fewer side effects and can produce good analgesic effect of anesthesia.更多还原