标题：右美托咪定对颈丛阻滞下甲状腺手术患者的镇痛效果及其安全性

      作者：陈红华 1，罗勇 1，熊建华 1，严达红 1，王云川 2    (1.中山市陈星海医院麻醉科，广东 中山 528415；2.琼海市人民医院麻醉科，海南 琼海 571400)

      卷次： 2017年28卷18期

      【摘要】 目的 研究右美托咪定对颈丛阻滞下甲状腺手术患者的镇痛效果及其安全性。方法 将2013年1月至2016年5月在中山市陈星海医院和琼海市人民医院就诊的90例颈丛阻滞下甲状腺手术患者按麻醉方式分为对照组(38例)和观察组(52例)。观察组术中给予右美托咪定麻醉，对照组术中给予罗哌卡因麻醉。术中记录入室时(T0)、阻滞后5 min (T1)、30 min (T2)、60 min (T3)时间点的舒张压(DBP)、收缩压(SBP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)值，同时进行Ramsay镇静评分(RSS)；术后记录并发症发生情况。结果 两组患者T0时的心率及其血液动力学、呼吸指标参数和Ramsay镇静评分比较差异无统计学意义(P>0.05)。对照组T1、T2、T3时的HR、SBP和DBP值均明显高于T0，差异有显著统计学意义(P<0.01)。观察组在T1、T2、T3时的HR、SBP和DBP值均明显低于T0，差异有显著统计学意义(P<0.01)。两组RR和SpO2在T0、T1、T2、T3时差异均无统计学意义(P>0.05)。观察组并发症发生率为7.69%，低于对照组的26.3%，差异有统计学意义(P<0.05)。观察组RSS值在T1、T2、T3时均明显高于T0和对照组，差异有显著统计学意义(P<0.01)。结论 行颈丛阻滞下甲状腺手术中使用右美托咪定可降低患者心率和并发症并减轻疼痛。
      【关键词】 右美托咪定；甲状腺手术；颈丛阻滞；镇痛；心率
      【中图分类号】 R653 【文献标识码】 A 【文章编号】 1003—6350（2017）18—2988—03

Efficacy and safety of dexmedetomidine in patients undergoing thyroid surgery under cervical plexus block.CHEN Hong-hua 1, LUO Yong 1, XIONG Jian-hua 1, YAN Da-hong 1, WANG Yun-chuan 2.
1. Department ofAnesthesiology, Zhongshan Chenxinghai Hospital, Zhongshan 528415, Guangdong, CHINA; 2. Department ofAnesthesiology, Qinghai People's Hospital, Qinghai 571400, Hainan, CHINA
【Abstract】 Objective To study the anaesthetic effect and safety of dexmedetomidine in patients undergoingthyroid surgery under cervical plexus block. Methods From Jan. 2013 to May 2016, 90 patients undergoing thyroid sur-gery under cervical plexus were assigned to control group (n=38) and observation group (n=52) according to anesthesia.The observation group was given dexmedetomidine for anesthesia, while the control group was given ropivacaine for an-esthesia. Diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR), oxygensaturation (SpO2) were recorded before anesthesia (T0), 5 min (T1), 30 min (T2), 60 min (T3) after anesthesia, and Ram-say Sedation Scale (RSS) scores were assessed. The postoperative complications were recorded. Results Two groupsof patients showed no statistically significant difference at T0 in HR, hemodynamic and respiratory parameters, and RSSscores (P>0.05). The HR, SBP and DBP values at T1, T2, T3 were significantly higher than those at T0 in control group(P<0.01), while the values at T1, T2, T3 were significantly lower than those at T0 in the observation group (P<0.01). RRand SPO2 were similar between two groups at T0, T1, T2, T3. The incidence of complications was 7.69% in the observa-tion group, versus 26.3% in the control group (P<0.01). RSS scores at T1, T2 and T3 in the observation group were sig-nificantly higher than those at T0 in the observation group and those in the control group (P<0.01). Conclusion Appli-cation of dexmedetomidine in thyroid surgery under cervical plexus block can decrease heart rate, reduce complications,and relieve pain, which is worth to be promoted in clinical practice.
      【Key words】 Dexmedetomidine; Thyroid surgery; Cervical plexus block; Sedation; Heart rate (HR)·论 著·doi:10.3969/j.issn.1003-6350.2017.18.018基金项目：广东省科技计划项目(编号：2015B360D1036)