| Objective：To investigate the effect of dexmedetomidine combined with ultrasound-guidedcervical plexus block in thyroid surgery, find out advantages and disadvantages of thismethod compared with general anesthesia. To provide a method for anesthesiologistsin thyroid surgery.Methods：Sixty patients(Age18～50years, Male or female, ASAI～II) undergoing electivethyroidectomy were randomly divided into two groups of30patients each．In group I,patients were injected dexmedetomidine and accepted cervical plexus block; Ingroup II, patients were injected dexmedetomidine and accepted general anesthesia.Visit patients before the day of surgery and told them something they need to know,make sure that patients would cooperate with the doctors. Oxygen and intravenousinjection of dexmedetomidine was given in both groups with a speed of1.0ug/kg/min and completed the injection in10minutes after patients got into operation room.Anesthesiologists made a deep and superficial cervical nerve block in the surgicalside and a superficial cervical nerve block in the non-surgical side to patient in groupI with the help of ultrasound pictures, inject5ml mixture of1%lidocaine and0.5%ropivacaine in each block point. Injected0.1mg fentanyl before the thyroidectomy.The SBP, DBP, HR of each patient were recorded at the point of entering theoperation room (T0), before nerve block (T1), after nerve block (T2) and after skinincision (T3). Anesthesia was induced by fentanyl (3-5ug/kg), propofol (2-2.5mg/kg),atracurium amine (1mg/kg)(2times ED95). Intubation was done after inductionadministration. Anesthesia maintenance was provided by continuous pumping ofpropofol(4-10mg/kg/h), atracurium(0.3-0.6mg/kg/h) and remifentanil(0.2ug/kg/min)in group II. The SBP, DBP, HR of each patient were recorded at the point of enteringthe operation room (T0), before induction (T1), after induction (T2), before skin incision (T3) and after skin incision(T3). Recorded the intraoperative Ramsay scoreof patients in group I. Distinguished the change of voice and observed if the patienthad uncomfortable symptoms. The24and48hours follow-up around18：00，including anesthesia fees, wound drainage, nausea and/or vomiting, hoarseness.Results：1、The structure of sexual distinction, ages, weight, ASA classification and lesionsize had no significant difference（P>0.05）between the two groups.2、The patients’SBP, DBP, HR at T0had no significant difference（P>0.05）inthe two groups;3、In Group I, compared with T0, the patients’ SBP, DBP, HR at T1, T2had nosignificant difference（P>0.05）; Compared with T2, the patients’SBP, DBP, HR at T3had no significant difference （P>0.05）;4、In Group II, compared with T0, the patients’ SBP, DBP, HR at T1had nosignificant difference（P>0.05）; Compared with T0, the patients’SBP, DBP, HR at T2had significant differenc（eP<0.05）; Compared with T2, the patients’SBP, DBP, HRat T3had significant difference（P<0.05）;5、Intraoperative sedative effect in Group I was good enough for the thyroidsurgery;6、The incidence of recurrent laryngeal nerve injury had no significant difference（P>0.05）in the two groups;7、The postoperative wound drainage had no significant difference（P>0.05）;8、 Compared with Group II, anesthesia fees of Group I was less and hadsignificant difference（P<0.05）;9、Compared with Group II, The incidence of throat discomfort and nausea andvomiting of Group I was less and had significant difference（P<0.05）;Conclusion：Under the conditions of this experiment, dexmedetomidine combined withcervical plexus block with the help of ultrasound pictures could be successfully usedin thyroid surgery. Patients could coordinate the surgeon to make a neurological examination in the condition that patient had a good sedation. Compared with generalanesthesia, dexmedetomidine combined with cervical plexus block can make patientshave a more stable hemodynamics, save medical resources, reduce the cost ofanesthesia and postoperative complications. Laryngeal recurrent nerve injury rate hadno difference between the two groups. |
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