芬太尼复合利多卡因布比卡因混合液用于颈丛阻滞的临床观察

目的 观察芬太尼复合利多卡因布比卡因混合液用于颈丛阻滞对心率、血压的影响。方法 择期甲状腺腺瘤行甲状腺次全切除术的病人40例,ASAⅠ～Ⅱ级,无内分泌疾患。按手术顺序分为A(观察组),B(对照组)。局麻药选用利多卡因和布比卡因混合液,A组加适量的芬太尼(芬太尼2μg/kg计算),B组不加芬太尼。穿刺采用颈4一针法,阻滞一侧颈深和双侧颈浅。观察心率、血压的变化,以及对症处理情况。结果 收缩压(SBP),A组波动范围小,而B组波动范围大,各时段组间比较,P<0.05,组内比较,P<0.05。心率,A组在阻滞后较平稳;B组阻滞后均明显上升。各时段组间比较,P<0.05,组内比较,P<0.05。阻滞后对症处理例数:A组4例,B组9例。结论 局麻药中复合芬太尼行颈丛阻滞用于甲状腺手术病人,能增强阻滞效果,解除病人的精神紧张,并有效地控制心率增快和血压升高,明显减轻颈丛阻滞后心血管的不良反应,低浓度的局麻药混合液能降低其副作用,从而提高了颈丛阻滞的安全性。

The Clinical Observation of Fentanyl Combined with Lidocaine and Bubicaine on Cervical Plexus Block Anaesthesia

Objective To observe the influence of the mix of fentanyl, lidocaine and bupivacaine on heart rate and blood pressure in cervical plexus block anaesthesia. Methods 40 patients with thyroid adenoma of ASA I - II , who were determined to be given subtotal thyroidectomy were enrolled. All the patients suffered from no endrocrinopathy, and were divided into Group A (observing group) and Group B ( control group) according to the operative sequence. Group A was administered the mix of lidocaine and bupivacaine, and Group B fentanyl (2 μg/kg) in addition to the mix. Puncture was located at C4 to block lateral superficial cervical plexus and bilateral deep cervical plexuses. The changes of heart rate and blood pressure were monitored. Results The fluctuation of systolic blood pressrre (SBP) of Group A was smaller than that of Group B at variety of periods of time ( P < 0.05 ). The heart rate of Group A kept stable, while that of Group B increased markedly. The difference of heart rate between the two groups was significant at every time span( P < 0.05 ). 4 patients of Group A and 9 of Group B needed heterotherapy because of adverse reaction. Conclusion It is deemed that Fentanyl plus other local anaesthetics have a good effect on cervical plexus block in thyroid operation, in the aspect of controlling heart rate and blood pressure, lowing adverse reaction and even abating stress.