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地塞米松
辅助
神经
阻滞
联合
骨近端
手术
麻醉
中的
应用
价值
冯骥
tion cytology of cystic cervical lymph node metastasis from papillary thy-roid carcinomaJ Diagn Cytopathol,2022,50(7):350 356 4Haugen B,Alexander EK,Bible KC,et al 2015 American thyroidassociation management guidelines for adult patients with thyroid nodulesand differentiated thyroid cancer:The American thyroid associationguidelines task force on thyroid nodules and differentiated thyroid cancerJ Thyroid,2016,26(1):1 133 5Leenhardt L,Erdogan MF,Hegedus L,et al 2013 European thyroidassociation guidelines for cervical ultrasound scan and ultrasound guided techniques in the postoperative management of patients with thy-roid cancerJ Eur Thyroid J,2013,2(3):147 159 6Wang J,Jiang X,Xiao G,et al Excellent diagnostic performance ofFNA tg in detecting lymph nodes metastases from papillary thyroidcancerJ Future Oncol(Lond Engl)2020,16(33):2735 2746 7柴吉鑫,齐艳涛,王婧婧,等 细针穿刺细胞学联合洗脱液甲状腺球蛋白检测对甲状腺癌颈部淋巴结转移诊断价值J 河北医学,2022,28(3):390 394 8Megwalu U,Moon PK Thyroid Cancer Incidence and Mortality Trendsin the United States:2000 2018J Thyroid,2022,32(5):560 570 9Kim DH,Kim GJ,Kim SW,et al Predictive value of ipsilateral centrallymph node metastasis for contralateral central lymph node metastasis inpatients with thyroid cancer:Systematic review and meta analysisJ Head Neck,2021,43(10):3177 3184 10 Feng JW,Qin AC,Ye J,et al Predictive Factors for Lateral LymphNode Metastasis and Skip Metastasis in Papillary Thyroid Carcinoma J Endocr Pathol,2020,31(1):67 76 11 Sanabria A,Betancourt C,Snchez JG,et al Prophylactic Central NeckLymph Node Dissection in Low isk Thyroid Carcinoma Patients Doesnot Decrease the Incidence of Locoregional ecurrence:A Meta Analy-sis of andomized Trials J Ann Surg,2022,276(1):66 73 12 Ahn JH,Kwak JH,Yoon SG,et al A prospective randomized con-trolled trial to assess the efficacy and safety of prophylactic central com-partment lymph node dissection in papillary thyroid carcinomaJ Sur-gery,2022,171(1):182 189 13 Jia X,Wang Y,Liu Y,et al Thyroglobulin Measurement Through Fine Needle Aspiration for Optimizing Neck Node Dissection in PapillaryThyroid CancerJ Ann Surg Oncol,2022,29(1):88 96 14 Kim K,Bae JS,Kim JS Measurement of thyroglobulin level in lateralneck lymph node fine needle aspiration washout fluid in papillary thyroidcancerJ Gland Surg,2021,10(9):2686 2694(收稿日期:2022 11 26)DOI:10 3969/j issn 1671 4695 2023 07 026文章编号:1671 4695(2023)07 0770 04地塞米松辅助神经阻滞联合丙泊酚闭环靶控输注在肱骨近端手术麻醉中的应用价值冯骥税云华张茺向芮张兰*(四川省骨科医院麻醉科四川成都610031)基金项目:四川省骨科医院科研项目(编号:2021MS11);四川省医学科研青年创新课题立项(编号:Q18065)*通讯作者:张兰,E mail:zlxmi163 com【摘要】目的探究地塞米松辅助神经阻滞联合丙泊酚闭环靶控输注在肱骨近端手术麻醉中的应用价值。方法前瞻性选择 2020 年 1 月至 2022 年 4 月四川省骨科医院收治肱骨近端手术患者 82 例为研究对象,根据入院时间进行分组处理,2020 年 1 月至2021 年2 月收治41 例为对照组,给予丙泊酚闭环靶控输注镇静,2021 年3 月至2022 年4 月收治 41 例患者为观察组,给予地塞米松辅助神经阻滞联合丙泊酚闭环靶控输注。比较麻醉前(T0)、诱导时(T1)、切皮时(T2)、切口缝合时(T3)、术后 30 min(T4)时间段脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2),以及术毕时的肾上腺素(NE)、皮质醇差异,统计记录两组患者感觉阻滞持续时间、运动阻滞持续时间;并统计记录两组患者寒战、苏醒期躁动、恶心/呕吐不良发应发生情况。结果观察组 T1、T2、T3、T4时间段 SpO2分别为(96 04 1 10)%、(95 74 1 13)%、(96 73 1 07)%、(97 07 1 02)%,均较对照组(94 76 1 12)%、(94 19 1 15)%、(95 00 1 17)%、(96 48 1 14)%高,差异均有统计学意义(P 0 05)。观察组 T1、T2、T3、T4时间段 PETCO2分别为(37 04 1 18)、(38 43 1 37)、(37 53 1 16)、(36 92 1 13)mmHg,较对照组(35 14 1 20)、(38 43 1 37)、(34 50 1 25)、(35 23 1 18)mmHg 高,差异均有统计学意义(P 0 05)。观察组术毕时 NE 为(320 46 16 27)ng/mL,较对照组(358 37 18 58)ng/mL 低,皮质醇为(221 34 19 83)ng/mL,较对照组(268 49 21 18)ng/mL低,差异均有统计学意义(P 0 05)。观察组感觉阻滞持续时间、运动阻滞持续时间为(30 12 5 40)、(16 38 4 89)min,较对照组(16 28 3 46)、(12 03 2 71)min 长,差异均有统计学意义(P 0 05)。观察组不良发应发生率为 9 76%,较对照组 26 83%低,差异有统计学意义(P 0 05)。结论地塞米松辅助神经阻滞联合丙泊酚闭环靶控输注镇静方式用于肱骨近端手术麻醉中,不仅可维持呼吸状态,延长神经阻滞时间,还能缓解术中应激反应,降低不良反应发生率,值得推广。【关键词】地塞米松神经阻滞丙泊酚闭环靶控输注肱骨近端手术镇静效果应激反应Application value of dexamethasone assisted nerve block combined with propofol closed loop target controlled infusion in anesthesia ofproximal humerus surgery FENG Ji,SHUI Yun hua,ZHANG Chong,et al Department of Anesthesiology,Sichuan Orthopedic Hospital,077Journal of Clinical and Experimental Medicine Vol22,No7Apr2023Chengdu Sichuan 610031,China【Abstract】ObjectiveTo explore the application value of dexamethasone assisted nerve block combined with propofol closed loop targetcontrolled infusion in anesthesia of proximal humerus surgery MethodsA total of 82 patients with proximal humeral surgery admitted to SichuanOrthopedic Hospital from January 2020 to April 2022 were prospectively selected as the study objects According to the time of admission,theywere divided into groups for treatment Forty one patients admitted from January 2020 to February 2021 were treated as the control group withpropofol closed loop target controlled infusion for sedation Forty one patients admitted from March 2021 to April 2022 were treated as the ob-servation group with dexamethasone assisted nerve block combined with propofol closed loop target controlled infusion The differences of pulseblood oxygen saturation(SpO2),end expiratory carbon dioxide partial pressure(PETCO2),epinephrine(NE),and cortisol were compared be-fore anesthesia(T0),at induction(T1),at skin i