CAJ | 학술논문

目的：研究颈丛阻滞下对地氟醚复合瑞芬太尼用于甲状腺手术麻醉用药量、术后苏醒及疼痛的影响。方法选择60例拟行甲状腺手术的患者，随机分为全麻组（Ⅰ组）和全麻复合双侧颈浅丛阻滞组（Ⅱ组），每组30例。全麻诱导均为咪达唑仑0.03 mg/ kg，舒芬太尼0.3μg/ kg，异丙酚2 mg/ kg，顺式阿曲库铵0.15 mg/ kg。麻醉诱导插管后，Ⅰ组吸入6%地氟醚，泵入瑞芬太尼0.1~1μg/（kg·min）维持麻醉；Ⅱ组吸入4%地氟醚，泵入瑞芬太尼0.1~1μg/ kg/ min 维持麻醉，同时以0.375%左旋布比卡因行双侧颈浅丛阻滞。术中调整瑞芬太尼泵入速度维持 BIS 值在45~55之间。术毕停用所有麻醉药，记录呼吸恢复时间、苏醒时间、拔管时间、术中知晓发生率；记录苏醒后0、2、4、8、12、24 h 静息及运动（吞咽）的视觉模拟评分（VAS）；计算瑞芬太尼用药量。结果Ⅰ组苏醒后0、2、4、8、12h 静息及运动（吞咽）的视觉模拟评分（VAS）显著高于Ⅱ组（P≤0.05），苏醒后24h 的 VAS 无显著差异（P >0.05）；Ⅰ组的呼吸恢复时间、苏醒时间、拔管时间短于Ⅱ组（P≤0.05）；Ⅰ组的瑞芬太尼用药量大于Ⅱ组（P≤0.05）；所有患者术中均无术中知晓发生。结论全麻复合双侧颈浅丛神经阻滞可有效降低术中地氟醚和瑞芬太尼用量，缩短术后呼吸恢复时间、苏醒时间、拔管时间，减轻术后疼痛。
목적：연구경총조체하대지불미복합서분태니용우갑상선수술마취용약량、술후소성급동통적영향。방법선택60례의행갑상선수술적환자，수궤분위전마조（Ⅰ조）화전마복합쌍측경천총조체조（Ⅱ조），매조30례。전마유도균위미체서륜0.03 mg/ kg，서분태니0.3μg/ kg，이병분2 mg/ kg，순식아곡고안0.15 mg/ kg。마취유도삽관후，Ⅰ조흡입6%지불미，빙입서분태니0.1~1μg/（kg·min）유지마취；Ⅱ조흡입4%지불미，빙입서분태니0.1~1μg/ kg/ min 유지마취，동시이0.375%좌선포비잡인행쌍측경천총조체。술중조정서분태니빙입속도유지 BIS 치재45~55지간。술필정용소유마취약，기록호흡회복시간、소성시간、발관시간、술중지효발생솔；기록소성후0、2、4、8、12、24 h 정식급운동（탄인）적시각모의평분（VAS）；계산서분태니용약량。결과Ⅰ조소성후0、2、4、8、12h 정식급운동（탄인）적시각모의평분（VAS）현저고우Ⅱ조（P≤0.05），소성후24h 적 VAS 무현저차이（P >0.05）；Ⅰ조적호흡회복시간、소성시간、발관시간단우Ⅱ조（P≤0.05）；Ⅰ조적서분태니용약량대우Ⅱ조（P≤0.05）；소유환자술중균무술중지효발생。결론전마복합쌍측경천총신경조체가유효강저술중지불미화서분태니용량，축단술후호흡회복시간、소성시간、발관시간，감경술후동통。
Objective:To investigate the effect of cervical plexus block on the dosage of anesthetics,the degree of post-operative recovery and pain during desflurane combined with remifentanil anesthesia for thyroid surgery. Methods:Sixty pa-tients having elective thyroid surgery under general anesthesia were allocated randomly into two groups:groupⅠand groupⅡ,with 30 cases in each. We used Midazolam 0. 03mg / kg,Sufentanil 0. 3μg / kg ,propofol 2mg / kg and cis atracurium 0. 15mg / kg during the induction of anesthesia in both group. GroupⅠ adopted inhalation-intravenous general anesthesia, group Ⅱadopted inhalation-intravenous general anesthesia combined with cervical plexus block on both sides. After tracheal intubation,the depth of anesthesia was maintained by 6% desflurane and remifentanil 0. 1 ~ 1 μg/ kg/ min in group Ⅰand 4% desflurane,remifentanil 0. 1 ~ 1μg/(kg·min)and bilateral superficial cervical plexus block using 0. 375% levobupiv-acaine in group Ⅱ. The speed of remifentanil was adjusted to maintain BIS values between 45 ~ 55 in the surgery. Breath-ing recovery time,awakening time,extubation time and the incidence of intraoperative awareness were recorded after the sugery. The resting and exercise(swallowing)visual analog scale(VAS)after awaking 0,2,4,8,12,24h,and calcu-lated remifentanil dosage were recorded. Results:The visual analog scale(VAS)after waking 0,2,4,8,12h in group Ⅰwas significantly higher than that in group Ⅱ(P≤0. 05). There was no significant difference in VAS after waking 24h(P >0. 05). The breathing recovery time,awakening time and extubation time in group Ⅰ were shorter than those in group Ⅱ(P≤0. 05);The dosage of remifentanil in groupⅠwas greater than that in Ⅱ group(P≤0. 05). All patients had no intr-aoperative awareness. Conclusion:General anesthesia combined with bilateral superficial cervical plexus block can effec-tively reduce dosage of desflurane and remifentanil in the surgery,shorten postoperative respiratory recovery time,awaken-ing time,extubation time and reduce postoperative pain.