国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2009年
15期
80-82
,共3页
颈丛%神经阻滞%瑞芬太尼%甲状腺
頸叢%神經阻滯%瑞芬太尼%甲狀腺
경총%신경조체%서분태니%갑상선
Cervical plexus%Nerves block%Remifentanil%Thyroid gland
目的 评价双侧甲状腺次全切除术患者靶控输注瑞芬太尼联合颈丛阻滞的效果.方法 择期行双侧甲状腺次全切除术的患者30例,ASA Ⅰ或Ⅱ级,年龄30～64岁,颈丛阻滞满意后,在手术开始前5min靶控输注瑞芬太尼,初始血浆靶浓度为1.6 ng/ml,术中根据患者情况及手术刺激强度调整目标浓度,每次递增或递减0.2ng/ml,直至镇静达Ramsay镇静评分2～3分,或镇痛达口述镇痛评分(VPS)0～1分,手术结束前5 min停药.于颈丛阻滞前(T0)、颈丛阻滞后10 min(T1)、手术开始后5 min(T2)、30min(T3)、术中气管牵拉明显时(T4)和术毕(T5)记录平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、Ramsay评分及VPS评分;记录呼吸抑制、肌肉僵硬、恶心呕吐及皮肤瘙痒等不良反应的发生情况;记录每例患者瑞芬太尼的最大血浆靶浓度,计算其平均血浆靶浓度.结果 与T0时比较,各时点MAP、SpO2差异无统计学意义(P>0.05):Ramsay评分和VPS评分T2时开始升高,T3、T4时达高峰,T5时下降(P<0.05),Ramsay评分均为2～3分,VPS评分均为0～1分.镇静镇痛效果良好.无一例发生不良反应.瑞芬太尼的最终血浆靶浓度范围为1.6～5ng/ml,平均维持浓度为(3.4±1.0)ng/ml.结论 瑞芬太尼低血浆靶浓度TCI联合颈丛阻滞用于双侧甲状腺次全切除术安全有效,可以达到清醒镇痛的目的 ,且无明显不良反应.
目的 評價雙側甲狀腺次全切除術患者靶控輸註瑞芬太尼聯閤頸叢阻滯的效果.方法 擇期行雙側甲狀腺次全切除術的患者30例,ASA Ⅰ或Ⅱ級,年齡30～64歲,頸叢阻滯滿意後,在手術開始前5min靶控輸註瑞芬太尼,初始血漿靶濃度為1.6 ng/ml,術中根據患者情況及手術刺激彊度調整目標濃度,每次遞增或遞減0.2ng/ml,直至鎮靜達Ramsay鎮靜評分2～3分,或鎮痛達口述鎮痛評分(VPS)0～1分,手術結束前5 min停藥.于頸叢阻滯前(T0)、頸叢阻滯後10 min(T1)、手術開始後5 min(T2)、30min(T3)、術中氣管牽拉明顯時(T4)和術畢(T5)記錄平均動脈壓(MAP)、心率(HR)、脈搏血氧飽和度(SpO2)、Ramsay評分及VPS評分;記錄呼吸抑製、肌肉僵硬、噁心嘔吐及皮膚瘙癢等不良反應的髮生情況;記錄每例患者瑞芬太尼的最大血漿靶濃度,計算其平均血漿靶濃度.結果 與T0時比較,各時點MAP、SpO2差異無統計學意義(P>0.05):Ramsay評分和VPS評分T2時開始升高,T3、T4時達高峰,T5時下降(P<0.05),Ramsay評分均為2～3分,VPS評分均為0～1分.鎮靜鎮痛效果良好.無一例髮生不良反應.瑞芬太尼的最終血漿靶濃度範圍為1.6～5ng/ml,平均維持濃度為(3.4±1.0)ng/ml.結論 瑞芬太尼低血漿靶濃度TCI聯閤頸叢阻滯用于雙側甲狀腺次全切除術安全有效,可以達到清醒鎮痛的目的 ,且無明顯不良反應.
목적 평개쌍측갑상선차전절제술환자파공수주서분태니연합경총조체적효과.방법 택기행쌍측갑상선차전절제술적환자30례,ASA Ⅰ혹Ⅱ급,년령30～64세,경총조체만의후,재수술개시전5min파공수주서분태니,초시혈장파농도위1.6 ng/ml,술중근거환자정황급수술자격강도조정목표농도,매차체증혹체감0.2ng/ml,직지진정체Ramsay진정평분2～3분,혹진통체구술진통평분(VPS)0～1분,수술결속전5 min정약.우경총조체전(T0)、경총조체후10 min(T1)、수술개시후5 min(T2)、30min(T3)、술중기관견랍명현시(T4)화술필(T5)기록평균동맥압(MAP)、심솔(HR)、맥박혈양포화도(SpO2)、Ramsay평분급VPS평분;기록호흡억제、기육강경、악심구토급피부소양등불량반응적발생정황;기록매례환자서분태니적최대혈장파농도,계산기평균혈장파농도.결과 여T0시비교,각시점MAP、SpO2차이무통계학의의(P>0.05):Ramsay평분화VPS평분T2시개시승고,T3、T4시체고봉,T5시하강(P<0.05),Ramsay평분균위2～3분,VPS평분균위0～1분.진정진통효과량호.무일례발생불량반응.서분태니적최종혈장파농도범위위1.6～5ng/ml,평균유지농도위(3.4±1.0)ng/ml.결론 서분태니저혈장파농도TCI연합경총조체용우쌍측갑상선차전절제술안전유효,가이체도청성진통적목적 ,차무명현불량반응.
Objective To evaluate the effect of target controlled infusion (TCI) of Remifentanil com-bined with cervical plexus block in patients with bilateral subtotal thyroidectomy.Methods 30 cases of ASA Ⅰ～Ⅱ patients with selective bilateral subtotal thyroideetomy,the ages between 30 to 64 years old, received TCI of Remifentanil after satisfactory cervical plexus block 5 minutes before operations.Initial target plasma concentration was 1.6ng/ml.During operation, adjusted the target concentration according to the patients? situation and the stimu-lating intensity, increasing or decreasing of 0.2ng/ml by degrees every time, until reached the Ramsay sedation scale at 2～3 score.. Or, the sedation reached verbal pain scores (VPS) at 0～1 score. Then, the patients were stopped taking the medicine 5 minutes before the end of operation. Recorded the mean arterial pressure (MAP), heart rate (HR), pulse,oxygen saturation (SpO2), Ramsay sedation scale, and VPS at the time before cervical plexus block (T0), the time after cervical plexus block (T1), 5 minutes after operation(T2), 30 minutes after operation(T3), trachea were pulled in evidence(T4), and at the end of operation (T5).Recorded the appearance adverse reactions including: respiratory inhibition, muscles stiffness, nausea and vomitting, Itch of skin, etc.And, recorded the biggest plasma target con-centration and calculated the average plasma target cnncentration.Results Comparing with T0,the MAP, SpO2 at every time was short of statistic significance (P>0.05), Ramsay sedation scale and VPS began to hoist at T2, reached pinnacle at T3, T4, and descended at T5(P<0.05), all Ramsay sedation scale at 2～3 score and VPS at 0～1 score. The effect of sedation and analgesia were excellent. There was no adverse event occurred. The final plasma target concentration of Remifentanil was 1.6～5ng/ml.The maintained average concentration was (3.4±1.0)ng/ml.Con-clusions The effect of target controlled infusion (TCI) of Remifentanil combined with cervical plexus block in patients for bilateral subtotal thyroidectomy is safe. It can reach the purpose of analgesia with waking state, and there is no apparently adverse event occurred.
