【摘要】 目的 :比较颈丛阻滞、硬膜外阻滞下甲状腺手术应激反应的大小。方法 :选择ASAⅠ～Ⅱ级 ,女性 ,甲状腺手术患者 30例 ,年龄 2 2～ 5 5岁 ,术前无呼吸、循环和内分泌疾病 ,随机分为颈丛阻滞组 (颈丛组 ) 15例 ,硬膜外阻滞组(硬膜外组 ) 15例 ;颈丛阻滞选用 0 .8%利多卡因和 0 .2 5 %布比卡因混合液 ,以C4一点法行双侧深浅丛阻滞 ;硬膜外阻滞选用 1.3%利多卡因和 0 .15 %丁卡因混合液 ,穿刺点选择C4～ 5或C5～ 6间隙 ,采用侧卧位直入法 ,并向头置管 3cm ;分别测定并记录麻醉前、麻醉后 2 0min、切皮、分上极、切腺体和术毕共六个时点的血糖、血压和心率的变化。结果 :两组病例各时点血糖均逐步上升 ,于分上极、切腺体和术毕血糖值与麻醉前比较有显著性差异 (P <0 .0 1) ;硬膜外组只在分上极时SBP与麻醉前比较有差异外 (P <0 .0 5 ) ,而颈丛组在分上极、切腺体时DBP与麻醉前比较有差异 (P <0 .0 5 ) ,SBP、MAP与麻醉前比较有显著性差异 (P <0 .0 1)。结论 :本研究表明颈丛阻滞、硬膜外阻滞均不能完全抑制甲状腺手术的应激反应 ,在稳定甲状腺手术循环功能方面硬膜外阻滞优于颈丛阻滞更多还原

【Abstract】 Objective: To compare the stress response during thyroidectomy under cervical plexus block or epidural block. Methods:Thirty women aged 22～55 years old with ASA gradesⅠor Ⅱ were scheduled for thyroidectomy and allocated randomly into two groups (cervical plexus block group and epidural block group) with 15 in each group. A local anesthetic containing 0.8% of lidocaine and 0.25% of bupivacaine was employed in the cervical plexus block group.While in the epidural block group, 1.33% of lidocaine and 0.15% dicaine were used as local anesthetic.Blood glucose, blood pressure, and the heart rate were recorded at following time points: before anesthesia, at 20 min after anesthesia, diereticing skin, dissociating the upper pole of thyroid, cutting the body of thyroid, and the end of surgery. Results:The blood glucose gradually increased at each time point. Its values at dissociating the upper pole of thyroid, cutting the body of thyroid, and end of surgery were significantly higher than before anesthesia in both two groups ( P <0.01). In the epidural block group the systolic pressure at dissociating the upper pole of thyroid was higher than that before anesthesia( P <0.05). In the cervical plexus block group the diastolic pressure at dissociating the upper pole of thyroid and cutting the body of thyroid was higher than that before anesthesia( P <0.05). Meanwhile the systolic pressure and the mean arterial pressure were significantly higher than that before anesthesia( P <0.01). Conclusion:The study shows that both the cervical plexus block and the epidural block could not effectively repress the stress response during thyroidectomy. In contrast, the epidural block is better than the cervical plexus block in stabilizing the circulatory system.更多还原