广东医学
廣東醫學
엄동의학
GUNAGDONG MEDICAL JOURNAL
2014年
11期
1669-1672
,共4页
颈丛神经阻滞%全身麻醉%肾功能衰竭继发甲状旁腺功能亢进%甲状旁腺次全切除术
頸叢神經阻滯%全身痳醉%腎功能衰竭繼髮甲狀徬腺功能亢進%甲狀徬腺次全切除術
경총신경조체%전신마취%신공능쇠갈계발갑상방선공능항진%갑상방선차전절제술
cervical plexus block%general anesthesia%subtotal parathyroidectomy%uremic patients with secondary hyperparathyroidism
目的：比较单纯气管插管全麻与气管插管全麻联合颈丛神经阻滞用于慢性肾功能衰竭（ CRF）继发甲状旁腺功能亢进（SPHT）患者行甲状旁腺次全切除术的优、缺点。方法选择60例择期行甲状旁腺次全切除术的 CRF 继发 PHT 患者，ASAⅢ~Ⅳ级，分为3组：单纯全麻（GA）组、全麻联合双侧颈浅丛（BS）组和全麻联合双侧颈深浅丛（BD）组。每组20例。GA 组采用1％利多卡因与0.5％罗哌卡因混合液，经传统的一点法进行颈丛神经阻滞。BD 组每侧颈深、浅丛各注入5 mL，共计20 mL；BS 组每侧颈浅神经丛注入5 mL，共计10 mL。3组患者全麻插管诱导及维持采用相同的方法及药物，BS 组和 BD 组插入气管导管后行颈丛神经阻滞。监测并记录3组患者的血流动力学相关指标和神经内分泌应激激素水平的变化，拔管时间，拔管前、后躁动的发生率，术中全麻药物的用量等。结果 BS 组和 BD 组患者各项指标均优于 GA 组（P <0.05），其中又以 BD 组更为满意。结论气管插管全麻联合颈丛神经阻滞，特别是全麻联合双侧颈深浅丛阻滞是 CRF 继发 HPT 患者行甲状旁腺次全切除术的一种较为理想的麻醉方法。
目的：比較單純氣管插管全痳與氣管插管全痳聯閤頸叢神經阻滯用于慢性腎功能衰竭（ CRF）繼髮甲狀徬腺功能亢進（SPHT）患者行甲狀徬腺次全切除術的優、缺點。方法選擇60例擇期行甲狀徬腺次全切除術的 CRF 繼髮 PHT 患者，ASAⅢ~Ⅳ級，分為3組：單純全痳（GA）組、全痳聯閤雙側頸淺叢（BS）組和全痳聯閤雙側頸深淺叢（BD）組。每組20例。GA 組採用1％利多卡因與0.5％囉哌卡因混閤液，經傳統的一點法進行頸叢神經阻滯。BD 組每側頸深、淺叢各註入5 mL，共計20 mL；BS 組每側頸淺神經叢註入5 mL，共計10 mL。3組患者全痳插管誘導及維持採用相同的方法及藥物，BS 組和 BD 組插入氣管導管後行頸叢神經阻滯。鑑測併記錄3組患者的血流動力學相關指標和神經內分泌應激激素水平的變化，拔管時間，拔管前、後躁動的髮生率，術中全痳藥物的用量等。結果 BS 組和 BD 組患者各項指標均優于 GA 組（P <0.05），其中又以 BD 組更為滿意。結論氣管插管全痳聯閤頸叢神經阻滯，特彆是全痳聯閤雙側頸深淺叢阻滯是 CRF 繼髮 HPT 患者行甲狀徬腺次全切除術的一種較為理想的痳醉方法。
목적：비교단순기관삽관전마여기관삽관전마연합경총신경조체용우만성신공능쇠갈（ CRF）계발갑상방선공능항진（SPHT）환자행갑상방선차전절제술적우、결점。방법선택60례택기행갑상방선차전절제술적 CRF 계발 PHT 환자，ASAⅢ~Ⅳ급，분위3조：단순전마（GA）조、전마연합쌍측경천총（BS）조화전마연합쌍측경심천총（BD）조。매조20례。GA 조채용1％리다잡인여0.5％라고잡인혼합액，경전통적일점법진행경총신경조체。BD 조매측경심、천총각주입5 mL，공계20 mL；BS 조매측경천신경총주입5 mL，공계10 mL。3조환자전마삽관유도급유지채용상동적방법급약물，BS 조화 BD 조삽입기관도관후행경총신경조체。감측병기록3조환자적혈류동역학상관지표화신경내분비응격격소수평적변화，발관시간，발관전、후조동적발생솔，술중전마약물적용량등。결과 BS 조화 BD 조환자각항지표균우우 GA 조（P <0.05），기중우이 BD 조경위만의。결론기관삽관전마연합경총신경조체，특별시전마연합쌍측경심천총조체시 CRF 계발 HPT 환자행갑상방선차전절제술적일충교위이상적마취방법。
Objective To compare the efficacy and safety between single general anesthesia and general anesthe-sia plus cervical plexus block for the subtotal parathyroidectomy of uremia patients with secondary hyperparathyroid-ismMethods A total of 60 patients(ASA Ⅱ - Ⅲ)with subtotal parathyroidectomy were randomly divided into three groups(n = 20):general anesthesia(GA group),general anesthesia plus bilateral superficial cervical plexus block(BS group)and general anesthesia plus combined bilateral deep and superficial cervical plexus block(BD group). Anesthesia was induced with midazolam,propofol,fentanyl,and cis - atracurium. In BS group and BD group,the cervical plexus blockade was performed after endotracheal intubation. The general anesthesia was maintained by continuing injection of propofol and remifentanil by infusion pump. The hemodynamic parameters and the levels of neuroendocrine stress hor-mones were monitored and recorded intermittently. The time of the extubation,the incidences of agitation before and after extubation,and the cumulative usage of general anesthetics were recorded. Results Significantly better efficacy and safe-ty of anesthesia were observed in BS group and BD than GA group(P < 0. 05),especially in BS group. Conclusion For subtotal parathyroidectomy in uremia patients with secondary hyperparathyroidism,the general anesthesia plus cervical plexus block provides better efficacy and safety.
