美洛昔康预处理联合超声引导下喉上神经阻滞在甲状腺癌手术患者围术期中的应用

朱光亮; 沈俊; 李晓明; 陈本鑫

doi:10.16766/j.cnki.issn.1674-4152.002360

美洛昔康预处理联合超声引导下喉上神经阻滞在甲状腺癌手术患者围术期中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002360

1.
皖西卫生职业学院附属医院麻醉科，安徽六安 237000
2.
皖西卫生职业学院附属医院甲乳外科，安徽六安 237000

基金项目:

安徽省教育厅高校自然科学研究项目 KJ2019A1259

详细信息

通讯作者:
陈本鑫，E-mail：mzszla2280@163.com

中图分类号: R614.24 R736.1
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- 文章访问数: 159
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- 被引次数: 0
出版历程
- 收稿日期: 2021-06-21
- 网络出版日期: 2022-08-13

Application of meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block in perioperative period of radical thyroidectomy patients

1.
Department of Anesthesiology, Affiliated Hospital of West Anhui Health Vocational College, Lu'an, Anhui 237000, China

摘要

摘要: 目的探讨美洛昔康预处理联合超声引导下双侧喉上神经阻滞在甲状腺癌根治术患者围术期中的应用效果。方法选择2019年12月—2021年2月皖西卫生职业学院附属医院收治的甲状腺癌根治术患者76例，按照随机数字表分为M组和C组，各38例。M组于术前口服美洛昔康进行预处理，C组口服安慰剂。M组行超声引导下双侧喉上神经内侧支阻滞联合全麻，C组行全麻。记录2组的血流动力学指标、术后VAS评分、应激反应、术后恢复情况以及不良反应。结果 M组T2~T4时的平均动脉层(MAP)及心率(HR)均低于C组(均P＜0.05)，M组术后2、4、12、24、48 h VAS评分均低于C组(均P＜0.05)，M组术后24 h左甲肾上腺素(NE)、hs-CRP、IL-1β均低于C组(均P＜0.01)；M组术后24 h β内啡肽(β-EP)浓度高于C组(P＜0.01)；M组术后首次进饮时间、床旁活动时间、住院时间分别为(5.6±1.3)h、(16.2±4.7)h、(11.5±2.2)d，均短于C组的(6.8±1.7)h、(18.9±5.3)h、(12.7±2.8)d(均P＜0.05)；M组拔管呛咳、术后补救镇痛、咽喉疼痛发生率为7.9%、13.2%、13.2%，均低于C组的39.5%、42.1%、39.5%(均P＜0.01)，M组恶心呕吐发生率(5.3%)低于C组(23.7%，P＜0.05)。结论美洛昔康预处理联合超声引导下双侧喉上神经内侧支阻滞用于甲状腺癌手术患者有效抑制围术期应激反应，有效缓解术后疼痛，促进患者术后康复。
- 美洛昔康 /
- 喉上神经阻滞 /
- 预处理 /
- 超声引导 /
- 甲状腺癌根治术
Abstract: Objective To observe the effect of meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block in patients with radical thyroidectomy. Methods Seventy-six thyroid cancer patients admitted at the Affiliated Hospital of West Anhui Health Vocational College from December 2019 to February 2021 were selected and randomly divided into group M and group C, with 38 cases in each group. Group M was pretreated with meloxicam before operation, and group C was treated with placebo. Group M was given ultrasound-guided internal branch of superior laryngeal nerve block combined with general anaesthesia, whereas group C was given general anaesthesia. The hemodynamic indexes, postoperative VAS score, stress reaction, postoperative recovery and adverse reactions of the two groups were observed. Results The mean arterial pressure (MAP) and heart rate (HR) at T2, T3 and T4 in group M were lower than those in group C (all P < 0.05). The VAS score 2, 4, 12, 24 and 48 h after operation in group M were significantly lower than in group C (all P < 0.05). The levels of norepinephrine (NE), hs-CRP and IL-1β 24 h after operation in group M were significantly lower than those in group C (all P < 0.01). The levels of β Endorphins (β-EP) 24 h after operation in group M were significantly higher than those in group C (P < 0.01). The time of first intake, bedside activity time and length of hospital stay [(5.6±1.3) h, (16.2±4.7) h and (11.5±2.2) days] in group M were significantly lower than those in group C [(6.8±1.7) h, (18.9±5.3) h and (12.7±2.8) days], all P < 0.05. The incidence of coughing during emergence, antiemetic rescue and postoperative sore throat (7.9%, 13.2% and 13.2%) in group M were significantly lower than those in group C (39.5%, 42.1% and 39.5%, all P < 0.01). The incidence of nausea and vomiting (5.3%) in group M was significantly lower than that in group C (23.7%, P < 0.05). Conclusion Meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block effectively inhibits perioperative stress response, effectively relieves postoperative sore throat and promotes postoperative rehabilitation in patients with radical thyroidectomy.
- Meloxicam /
- Superior laryngeal nerve /
- Pretreatment /
- Ultrasound-guided /
- Radical thyroidectomy

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表 1 2组甲状腺癌患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with thyroid cancer

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	ASA分级(例)		手术时间 (x±s，min)	术中出血量 (x±s，mL)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	Ⅰ	Ⅱ	手术时间 (x±s，min)	术中出血量 (x±s，mL)
M组	38	10	28	49.6±9.3	23.4±3.6	25	13	128.6±18.1	18.5±5.8
C组	38	10	28	48.7±9.5	23.8±3.5	26	12	125.3±17.5	18.7±4.9
统计量				0.417^a	0.491^a	0.060^b		0.808^a	0.200^a
P值				0.678	0.625	0.807		0.422	0.871
注：^a为t值，^b为χ²值。

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表 2 2组甲状腺癌患者不同时点血流动力学指标比较(x±s)

Table 2. Comparison of hemodynamics between the two groups of patients with thyroid cancer at different time points (x±s)

组别	例数	MAP(mm Hg)
组别	例数	T0	T1	T2	T3	T4
M组	38	104.3±14.6	92.5±11.3^a	95.7±10.4^a	93.6±10.2^a	100.6±12.7
C组	38	105.2±13.8	93.5±12.2^a	103.2±12.6	99.9±11.3^a	107.8±13.5
t值		-0.276	-0.371	-2.273	-2.490	-2.129
P值		0.783	0.712	0.026	0.015	0.037

组别	例数	HR(次/min)
组别	例数	T0	T1	T2	T3	T4
M组	38	88.2±13.5	76.7±9.3^a	79.4±9.7^a	72.6±7.8^a	80.2±9.3^a
C组	38	88.6±14.2	76.6±8.9^a	84.8±11.7	77.1±8.3^a	86.3±10.7
t值		-0.126	0.048	-2.190	-2.435	-2.218
P值		0.900	0.962	0.032	0.017	0.030
注：与T0比较，^aP＜0.05。

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表 3 2组甲状腺癌患者术后不同时点VAS评分比较(x±s，分)

Table 3. The VAS scores between the two groups of patientswith thyroid cancer at different time pointsby the end of surgey (x±s, points)

组别	例数	术后2 h	术后4 h	术后12 h	术后24 h	术后48 h
M组	38	3.85±0.55	2.63±0.51^a	2.48±0.43^a	2.23±0.45^a	1.52±0.24^a
C组	38	4.16±0.66	2.95±0.62^a	2.72±0.55^a	2.47±0.56^a	1.66±0.31^a
t值		2.224	2.457	2.119	2.059	2.201
P值		0.029	0.016	0.037	0.043	0.031
注：与术后2 h比较，^aP＜0.05。

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表 4 2组甲状腺癌患者术后24 h NE、hs-CRP、IL-1β、β-EP比较(x±s)

Table 4. Changes of NE, hs-CRP, IL-1β, β-EP in the twogroups of patients with thyroid cancer after surgey (x±s)

组别	例数	NE (pg/mL)	hs-CRP (mg/L)	IL-1β (pg/mL)	β-EP (pg/mL)
M组	38	103.2±12.6	7.5±1.4	10.6±3.7	135.1±16.2
C组	38	143.8±15.3	11.4±3.2	18.3±5.6	115.5±13.7
t值		6.407	6.883	7.072	5.695
P值		＜0.001	＜0.001	＜0.001	＜0.001

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表 5 2组甲状腺癌患者术后恢复情况比较(x±s)

Table 5. Comparison of postoperative recovery between the twogroups of patients with thyroid cancer (x±s)

组别	例数	首次进饮时间(h)	床旁活动时间(h)	住院时间(d)
M组	38	5.6±1.3	16.2±4.7	11.5±2.2
C组	38	6.8±1.7	18.9±5.3	12.7±2.8
t值		2.592	2.350	2.077
P值		0.012	0.022	0.041

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表 6 2组甲状腺癌患者术后不良反应发生情况比较[例(%)]

Table 6. The adverse effects between the two groups of patientswith thyroid cancer [cases (%)]

组别	例数	拔管呛咳	补救镇痛	恶心、呕吐	声音嘶哑	咽喉疼痛
M组	38	3(7.9)	5(13.2)	2(5.3)	1(2.6)	5(13.2)
C组	38	15(39.5)	16(42.1)	9(23.7)	3(7.9)	15(39.5)
χ²值		10.483	7.962	5.208		6.786
P值		0.001	0.005	0.022	0.615^a	0.009
注：^a为采用Fisher精确检验。

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