| 颈浅丛神经阻滞复合瑞芬太尼静脉泵注在尿毒症患者行甲状旁腺手术中的应用 |
| 投稿时间：2011-06-21 修订日期：2011-06-29 点此下载全文 |
| 引用本文：祝卿,吉伟,赵喜越,王良荣,林丽娜.颈浅丛神经阻滞复合瑞芬太尼静脉泵注在尿毒症患者行甲状旁腺手术中的应用[J].医学研究杂志,2012,41(2):137-140 |
| DOI：
|
| 摘要点击次数: 1069 |
| 全文下载次数: 89 |
|
|
| 中文摘要:目的探讨颈浅丛神经阻滞复合瑞芬太尼静脉泵注在尿毒症继发性甲状旁腺功能亢进患者行甲状旁腺手术中的应用价值。 方法择期行甲状旁腺全切加前臂自体移植术的尿毒症患者27例，年龄29～69岁，ASAⅢ或Ⅳ级，随机分为全身麻醉组(GA，n=13)及颈浅丛神经阻滞复合瑞芬太尼组（CA，n=14）。GA组静脉注射咪达唑仑、舒芬太尼、罗库溴铵和异丙酚行麻醉诱导，气管插管后机械通气。麻醉维持采用异丙酚和瑞芬太尼持续静脉泵注，并间断给予罗库溴铵。CA组双侧颈浅丛阻滞完善后，于手术开始前5min静脉持续泵注瑞芬太尼0.05～0.10μg/（kg·min）至手术结束。记录手术持续时间、离室时间、术中输液量、血管活性药物使用情况。记录麻醉前（T0）、麻醉后5min（T1）、手术切皮后5min（T2）、手术中探查甲状腺上极（T3）和术毕（T4）时心率（HR）、平均动脉压（MAP）和血氧饱和度（SpO2），评定麻醉效果满意度，并随访术后透析情况及住院时间。 结果两组患者均顺利完成手术。与GA组比较，CA组离室时间缩短（P<0.01），术中输液量减少(P<0.05)；术毕时SpO2、MAP较高（P<0.05）；术后透析人数和透析次数减少（P<0.05）。结论颈浅丛神经阻滞复合瑞芬太尼静脉泵注麻醉方法可有效且安全的应用于尿毒症患者行甲状旁腺全切加自体前臂移植术。 |
| 中文关键词:颈浅丛神经阻滞 瑞芬太尼 尿毒症 继发性甲状旁腺功能亢进 甲状旁腺全切加自体前臂移植术 |
| |
| Application of Superficial Cervical Plexus Block Combined with Intravenous Infusion of Remifentanil for Parathyroid Surgery in Uremic Patients |
|
|
| Abstract:ObjectiveTo investigate the efficacy of superficial cervical plexus block combined with intravenous infusion of remifentanil for parathyroid surgery in uremic patients.MethodsTwenty-seven ASA Ⅲ or Ⅳ uremic patients aged 29-69 years undergoing elective total parathyroidectomy combined with partial autotransplantation were randomly assigned into general anesthesia group(GA,n=13) and superficial cervical plexus block combined with intravenous infusion of remifentanil group(CA,n=14). General anesthesia was induced with intravenous injection of midazolane, sufentanil, rocuronium and propofol. Thracheal intubation was performed and the patients were mechanically ventilated. Anesthesia was maintained with intravenous infusion of propofol and remifentail, intermittent bolus injection of rocuronium. Bilateral superficial cervical plexus block was performed in group CA, and 0.05-0.10μg/(kg·min) remifentanil was continuous intravenous infusion 5 minutes before operation till end of operation. The duration of operation, the time when of the patient left the operation room, the volume of fluid infused and the number of the patients who used the vasoactive drugs were recorded. Heart rate(HR), mean arterial pressure(MAP)and pulse oxygen saturation (SpO2) were recorded before anesthesia (T0), 5 mins after anesthesia (T1), 5 minutes after incision(T2), exploration of upper pole of the thyroid(T3) and at end of surgery(T4). The efficacy of anesthesia was evaluated and the doctors′ satisfaction was recorded. Records of the postoperative hospital stay and hemodialysis status were follow-up.ResultsOperation was performed successfully in all patients. As compared with group GA, the time of patient left the operating room, the volume of fluid infused, the number and the frequency of postoperative hemodialysis were significantly decreased,Moreover, SpO2 and MAP were significantly higher at T4 in group CA.ConclusionSuperficial cervical plexus block combined with intravenous infusion of remifentanil for total parathyroidectomy combined with partial autotransplantation in uremic patients showed satisfactory anesthesia effect and safe. |
| keywords:Cervical plexus block Remifentanil Uremia Secondary hyperparathyroidism Total parathyroidectomy combined with partial autotransplantation |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
