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    颈浅层阻滞复合针刺麻醉用于甲状腺手术加速康复外科的可行性

    Efficacy and effect of superficial cervical plexus block combined with acupuncture anesthesia for enhanced recovery after surgery in thyroid surgery

    • 摘要: 目的 探讨颈浅层阻滞复合针刺麻醉用于甲状腺手术加速康复外科(enhanced recovery after surgery,ERAS)的可行性。方法 择期行甲状腺腺瘤或囊肿切除手术的患者 50例,ASAⅠ~Ⅱ级,随机分为对照组和实验组,每组25例。对照组行颈丛阻滞麻醉,实验组行颈浅丛阻滞复合针刺麻醉,比较两组的麻醉效果及术后4h、8h、12h、24h镇痛评分,检测术前、术后即刻、术后1d的血糖(Glu)和超敏C反应蛋白(Hs-CPR)水平,记录术后声嘶、恶心呕吐、术后2h饮水呛咳的发生率及术后2h床上坐位活动的舒适度评分。结果 两组麻醉效果的优良率差异无统计学意义。实验组在术后4h、8h、12h各时点VAS评分较对照组显著降低(P<0.05)。术后即刻对照组的Glu浓度明显高于术前和实验组(P<0.05),术后1d对照组Glu浓度明显高于术前(P<0.05);术后即刻和术后1d对照组的Hs-CPR浓度明显高于术前和实验组(P<0.05),术后1d实验组Hs-CPR浓度明显高于术前(P<0.05)。两组患者术后声嘶和恶心呕吐的发生率没有明显差异,术后2h饮水呛咳的发生率实验组明显低于对照组(P<0.05),术后2h床上坐位活动的舒适度评分实验组明显高于对照组(P<0.05)。 结论 颈浅层阻滞复合针刺麻醉用于甲状腺手术,麻醉效果确切,安全性高,在减轻术后疼痛、降低围术期应激反应、促进早期进食和床上床下活动等方面具有明显的优势,可在甲状腺手术ERAS中选择应用。

       

      Abstract: Objective To investigate the efficacy and effect of superficial cervical plexus block combined with acupuncture anesthesia for enhanced recovery after surgery in thyroid surgery. Methods Fifty ASAⅠ-Ⅱpatients undergoing thyroid surgery were randomly divided into the control group(25 cases) and the treatment group(25 cases) by the random number table.Patients in the control group separately used simple cervical plexus block(0.25% ropivacaine hydrochloride).Patients in the treatment group used superficial cervical plexus block based on acupuncture anesthesia ,with acupoints of Neiguan ( PC 6 ) ,Hegu ( LI 4) given continuous electrical stimulation(1~34 Hz、 0~34 m A).Indicators of the two groups were observed,including anesthetic effect,pain score at the points of 4h、8h、12h、24h after the operation day,the level of glucose(Glu)and hypersensitive C-reactive protein (Hs-CPR) before and after the operation day,the occurrence rate of complications and early bed movement after the operation day. Results The visual analogue scale(VAS) pain score in treatment group was lower than that in control group (P<0.05)at the points of 4h、8h、12h after the operation day.The level of Glu in control group at the immediate time after surgery,CPR in control group at the immediate time after surgery and on the first postoperative day was higher than those in treatment group and before surgery(P<0.05) .The level of Glu in control group ,Hs-CPR in treatment group on the first postoperative day was higher than those before surgery.The occurrence rate of choking cough in treatment group at 2h after surgery was lower than that in control group.The bed activity comfort score in treatment group at 2h after surgery was higher than that in control group. Anesthetic effect and the occurrence rate of complications between the two groups had on statistical difference. Conclusion Superficial cervical plexus block combined with acupuncture anesthesia in thyroid surgery has very good analgesic effect and few complications,which can reduce postoperative pain and lower perioperative stress response and promote early eating and activity,so can be used for enhanced recovery after surgery in thyroid surgery.

       

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