超声引导喉上神经联合颈神经通路阻滞对甲状腺癌手术喉返神经监测的影响

doi:10.3969/j.issn.1006-5725.2019.16.018

实用医学杂志 ›› 2019, Vol. 35 ›› Issue (16): 2598-2602.doi: 10.3969/j.issn.1006-5725.2019.16.018

超声引导喉上神经联合颈神经通路阻滞对甲状腺癌手术喉返神经监测的影响

冯爱敏, 何双双, 卢锡华, 乔迎帅

郑州大学附属肿瘤医院（河南省肿瘤医院）麻醉科（郑州 450000）

收稿日期:2019-05-05 出版日期:2019-08-27 发布日期:2019-08-27
通讯作者: 乔迎帅 E-mail：qiaoyingshuai@163.com
基金资助:
河南省科技计划项目（编号：162102310316）

Effects of combination of superior laryngeal nerve block and cervical nerves pathway block on the monitoring of recurrent laryngeal nerve in thyroid cancer surgery

FENG Aimin, HE Shuangshuang, LU Xihua, QIAO Yingshuai

Department of Anesthesiology, Henan Tumor Hospital, Zhengzhou 450000, China

Received:2019-05-05 Online:2019-08-27 Published:2019-08-27
Contact: QIAO Yingshuai E-mail： qiaoyingshuai@163.com

摘要/Abstract

摘要： 目的评价超声引导喉上神经阻滞（superior laryngel nerve block,SLNB）联合颈神经通路阻滞（cervical nerves pathway block,CNPB）对甲状腺癌手术喉返神经监测的影响。方法甲状腺癌患者90例,采用随机数字表法分为2组,神经阻滞组（A组）和对照组（B组）。A组患者术前行超声引导喉上神经联合颈神经通路阻滞。观察A组患者神经阻滞前后声音、膈肌运动情况和SpO₂数值,患者插管条件评分和手术相关内容。记录25% TOFR恢复时间（T₁）、75% TOFR恢复时间（T₂）、90% TOFR恢复时间（T₃）、术者初次探查迷走神经时间（T₄）和探查喉返神经时间（T₅）及各时间点神经监测肌电信号波幅峰值。观察患者术后2 、12、24和48 h患者VAS评分,术后恶心呕吐和咽喉疼痛等不良反应。结果与A组相比,B组患者插管条件达到优等级例数明显减少,丙泊酚和瑞芬太尼用量增多,术中呛咳例数和术后咽喉疼痛例数增多,24 h内VAS评分增高。结论神经阻滞提高了患者插管条件,减少了术中丙泊酚和瑞芬太尼用量,降低了术中呛咳患者例数,减轻了患者术后咽喉疼痛和24 h内患者疼痛评分。

关键词: 神经阻滞, 甲状腺肿瘤, 罗哌卡因, 喉神经

Abstract: Objective To evaluate the effects of ultrasound-guided superior laryngeal nerve block （SLNB） combined cervical nerves pathway block （CNPB） on the monitoring of recurrent laryngeal nerve in thyroid cancer surgery. Methods A total of 90 patients with thyroid cancer surgery were divided into two groups by random number table method. Group A is nerve block and group B is observation control group. Patients in group A were given SLNB and CNPB before surgery. Sound condition, diaphragm movement and SpO₂ in group A were observed before and after nerve block. Patients intubation condition score and surgical related content. T1-T5 time and each time point peak amplitude of neuromuscular signal were observed. VAS scores of the patients at 2, 12, 24 and 48 h after surgery, as well as postoperative nausea, vomiting and throat pain and other adverse reactions were observed. Results Compared with group A, the number of patients in group B with superior intubation conditions was significantly lower. The dosages of propofol and remifentanil were increased. The numbers of patients with intraoperative cough and postoperative throat pain was increased. The VAS score was increased within 24 h. Conclusion Nerve block improved the intubation conditions of patients, reduced the intraoperative dosages of propofol and remifentanil. Nerve block reduced the number of patients with cough during the operation, the postoperative throat pain and VAS score of patients within 24 hours.

Key words: plexus block, thyroid neoplasms, ropivacaine, laryngeal nerves

冯爱敏, 何双双, 卢锡华, 乔迎帅. 超声引导喉上神经联合颈神经通路阻滞对甲状腺癌手术喉返神经监测的影响[J]. 实用医学杂志, 2019, 35(16): 2598-2602.

FENG Aimin, HE Shuangshuang, LU Xihua, QIAO Yingshuai. Effects of combination of superior laryngeal nerve block and cervical nerves pathway block on the monitoring of recurrent laryngeal nerve in thyroid cancer surgery[J]. The Journal of Practical Medicine, 2019, 35(16): 2598-2602.

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超声引导喉上神经联合颈神经通路阻滞对甲状腺癌手术喉返神经监测的影响

Effects of combination of superior laryngeal nerve block and cervical nerves pathway block on the monitoring of recurrent laryngeal nerve in thyroid cancer surgery

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