朱苗苗+黄科昌++陈乃葆

[摘要] 目的 研究羟考酮复合右美托咪定辅助颈丛神经阻滞下甲状腺切除手术麻醉的临床效果。 方法 将ASAⅠ～Ⅱ级60例行甲状腺切除的患者随机分为羟考酮复合右美托咪定组（D组）和右美托咪定组（C组），各30 例。D组取羟考酮5 mg于颈丛神经阻滞前10 min缓慢静注，随后静脉注射负荷量的右美托咪定0.5 μg/kg，输注时间10 min，继续以0.2 μg/（kg·h）速度持续泵注维持至缝皮；C组不予注射羟考酮，其他用药一致。监测记录两组患者T0、T1、T2及T3时点的平均动脉压（MAP）、心率（HR）、麻醉满意度。 结果 两组T0时点MAP、HR差异均无统计学意义（P均>0.05）。T1、T2、T3时点，两组MAP、HR差异均有统计学意义（P均<0.05）；在T2及T3时点，C组 MAP、HR明显高于T1时点，差异均有统计学意义（T2与T1时点MAP比较，t=10.527，P<0.05，与T1时点HR比较，t=12.712，P<0.05；T3与T1时点MAP比较，t=11.245，P<0.05，与T1时点HR比较，t=10.155，P<0.05）。D组患者满意度高于C组，差异有统计学意义（P<0.05）。 结论 羟考酮复合右美托咪定辅助用于颈丛神经阻滞麻醉能够减轻甲状腺切除术术中应激反应所导致的血流动力学变化。

[关键词] 羟考酮；右美托咪定；颈丛神经阻滞；应激反应；甲状腺切除术

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2016）23-0104-03

[Abstract] Objective To explore the clinical effect of oxycodone combined with dexmedetomidine in anesthesia of thyroid surgery under cervical plexus nerve block. Methods A total of 60 patients who were given thyroidectomy with ASA I toⅡgrade were randomly divided into oxycodone combined with dexmedetomidine group （group D） and dexmedetomidine group （group C）， each with 30 cases. Patients in group D were given oxycodone 5 mg i.v. at 10 min before cervical plexus nerve block， and then given intravenous injection of load capacity of dexmedetomidine 0.5 μg/kg for 10 min， which was continuously pumped at 0.2 μg/（kg·h） until skin closure. Patients in group C were given same procedures except that of oxycodone. The MAP， HR， and satisfaction of anesthesia at T0， T1， T2， and T3 were monitored and recorded. Results There was no significant difference in MAP or HR at T0 between two groups（P>0.05）. At T1， T2， and T3， there were significant differences in MAP and HR between two groups（P<0.05）. The MAP and HR of group C were significantly higher at T2 and T3 than T1（MAP： T2 vs T1， t=10.527， P<0.05，T3 vs T1， t=11.245， P<0.05， HR： T2 vs T1， t=12.712， P<0.05；T3 vs T1， t=10.155， P<0.05）. The satisfaction in group D was significantly higher than that in group C（P<0.05）. Conclusion Application of oxycodone combined with dexmedetomidine in anesthesia of thyroid surgery under cervical plexus nerve block can relieve the hemodynamic change casued by stress reaction.

[Key words] Oxycodone； Dexmedetomidine； Cervical plexus nerve block； Stress reaction； Thyroidectomy

颈丛神经阻滞麻醉用于甲状腺切除术可以保证患者术中的清醒与应答，但患者因恐惧和焦虑易造成交感神经兴奋、儿茶酚胺分泌增加[1]、颈丛神经阻滞后易出现血压高、心率快等表现，因此对麻醉方案有一定要求。右美托咪定作为一种α2-肾上腺素能受体激动药，其镇静镇痛作用显著，但是它对α1受体的作用较弱，对患者心血管系统的稳定性起改善作用，且对呼吸影响小[2，3]。羟考酮静脉给药的镇痛效能与吗啡相似，可防止中枢神经敏感化，起到超前镇痛的效果[4，5]。本研究中拟用羟考酮复合右美托咪定辅助颈丛神经阻滞下行甲状腺切除手术，观察其对甲状腺切除手术患者的血流动力学稳定性的影响。现报道如下。

1 资料与方法……