含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用

doi:10.13481/j.1671-587x.20160431

吉林大学学报(医学版) ›› 2016, Vol. 42 ›› Issue (04): 798-802.doi: 10.13481/j.1671-587x.20160431

含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用

李平^1,2, 杨燕青^1,3, 冯智英¹, 江仁², 李红², 和伟易², 沙洪存⁴

1. 浙江大学医学院附属第一医院疼痛科, 浙江杭州 310003;
2. 浙江省宁波市鄞州区第二医院麻醉科, 浙江宁波 315100;
3. 浙江省台州医院麻醉科, 浙江台州 317000;
4. 浙江省宁波市鄞州区第二医院普外科, 浙江宁波 315100

收稿日期:2015-12-06 发布日期:2016-07-20
通讯作者: 冯智英,主任医师,硕士研究生导师(Tel:0571-87236169,E-mail:fzy1972@zju.edu.cn) E-mail:fzy1972@zju.edu.cn
作者简介:李平(1983-),男,安徽省巢湖市人,主治医师,在读医学硕士,主要从事慢性炎性疼痛方面的研究。
基金资助:
浙江省卫计委医药卫生科研基金资助课题（2015KYA205）

Application of expansion liquid of ropivacaine hydrochloride during endoscopic thyroidectomy

LI Ping^1,2, YANG Yanqing^1,3, FENG Zhiying¹, JIANG Ren², LI Hong², HE Weiyi², SHA Hongcun⁴

1. Department of Pain Management, First Affiliated Hospital, School of Medical Sciences, Zhejiang University, Hangzhou 310003, China;
2. Department of Anesthesiology, Ningbo Yinzhou Second Hospital, Zhejing Province, Ningbo 315100, China;
3. Department of Anesthesiology, Taizhou Hospital, Zhejing Province, Taizhou 317000, China;
4. Department of General Surgery, Ningbo Yinzhou Second Hospital, Zhejiang Province, Ningbo 315100, China

Received:2015-12-06 Published:2016-07-20

摘要/Abstract

摘要：

目的：探讨含盐酸罗哌卡因的膨胀液对腔镜下甲状腺手术患者术后镇痛、镇静、血流动力学和不良反应等影响，阐明其临床应用的有效性和安全性。方法：择期行经胸乳路腔镜下甲状腺手术患者40例，根据使用膨胀液不同随机分为生理盐水组和含盐酸罗哌卡因膨胀液组（罗哌卡因组），每组20例。记录2组患者术前麻醉访视时（T₀）、注射膨胀液前（T₁）、手术结束时（T₂）和气管导管拔除时（T₃）的平均动脉压（MAP）和心率（HR），以及术中出血量、手术时间、术后引流量、住院天数和术后 24 h内恶心呕吐、呼吸抑制和局麻药毒性反应及术后切口感染、喉返神经损伤等不良反应。观察拔除气管导管后即刻（T₃）、0.5 h （T₄）、2 h （T₅）、6 h （T₆）、12 h （T₇）和24 h （T₈）各时间点患者的疼痛视觉模拟评分法（VAS）评分及T₃和T₄时间点的Ramsay镇静评分。结果：2组患者T₀和T₁时间点MAP和HR比较差异无统计学意义（ P > 0.05 ）；与生理盐水组比较，罗哌卡因组患者MAP和HR在T₂和T₃时间点均明显降低（P < 0.05 ）。2组患者手术时间、术中出血量、术后引流量和住院天数比较差异均有统计学意义（ P< 0.05 ）。与生理盐水组比较，罗哌卡因组患者术后 24 h追加镇痛药和恶心呕吐发生例数明显减少（ P< 0.05 ）。与生理盐水组比较，罗哌卡因组患者在T₃、T₄、T₅、T₆、T₇和T₈各时间点的VAS评分和T₃、T₄时间点的Ramsay镇静评分均明显降低（P < 0.05）。结论：含盐酸罗哌卡因的膨胀液可有效降低腔镜甲状腺手术期间的应激反应，并可提供良好的术后镇痛，减少手术引起的创伤。

关键词: 罗哌卡因, 术后疼痛, 腔镜甲状腺切除术

Abstract:

Objective: To study the effects of expansion of ropivacaine hydrochloride liquid on the postoperative analgesia, sedation, hemodynamic effects and adverse drug reactions of the patients underwent endoscopic thyroidectomy,and to explore its clinical effectiveness and safety. Methods: Forty patients who were to undergo endoscopic thyroidectomy via chest-breast approach were randomly assigned to saline solution group and expansion liquid of ropivacine hydrochloride group (ropivacaine group,n=20).The mean arterial pressure( MAP ) and heart rate( HR) were also evaluated at the following time points: preoperative evaluation(T₀), before local anesthetic infiltration(T₁), at the end of the operation(T₂); the blood loss, the operation time, the postoperative drainage, and the hospital duration of the patients in two groups were recorded;the nausea and vomiting, the respiratory depression,the toxicity response,the infection,and the recurrent laryngeal nerve injury during 24 h after operation were recorded. The postoperative pain scores were assessed at extubaltion(T₃),30 min(T₄),2 h(T₅),6 h(T₆),12 h (T₇) and 24 h (T₈) after extubation using Visual Analog Scale (VAS). The postoperative Ramsay scores were assessed at T₃ and T₄. Results: There were no significant differences in MAP and HR at T₀ and T₁ of the patients between two groups(P > 0.05). Compared with saline solution group, the MAP and HR at T₂ and T₃ of the patients in ropivacaine group were significantly decreased(P < 0.05).There were significant differences in the blood loss, the operation time,the postoperative drainage, and the hospital duration of the patients between two groups(P < 0.05).The number of patients required postoperative analgesia and the number patients with nausea and vomiting in ropivacaine group were decreased compared with saline solution group(P < 0.05). Compared with saline group, the VAS scores at T₃, T₄, T₅, T₆, T₇ and T₈ of the patients in ropivacaine group were significantly decreased(P < 0.05); the Ramsay scores at T₃ and T₄ of the patients in ropivacaine group were also decreased significantly(P < 0.05). Conclusion: Expansion liquid of ropivacaine hydrochloride can reduce the stress response during endoscopic thyroidectomy effectively and reduce the postoperative pain and injury induced by operation.

Key words: ropivacaine, postoperative pain, endoscopic thyroidectomy

中图分类号:

R614

李平, 杨燕青, 冯智英, 江仁, 李红, 和伟易, 沙洪存. 含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用[J]. 吉林大学学报(医学版), 2016, 42(04): 798-802.

LI Ping, YANG Yanqing, FENG Zhiying, JIANG Ren, LI Hong, HE Weiyi, SHA Hongcun. Application of expansion liquid of ropivacaine hydrochloride during endoscopic thyroidectomy[J]. Journal of Jilin University Medicine Edition, 2016, 42(04): 798-802.

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含盐酸罗哌卡因膨胀液在腔镜下甲状腺切除手术中的应用

Application of expansion liquid of ropivacaine hydrochloride during endoscopic thyroidectomy

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