【罂粟摘要】超声引导下行双侧颈浅丛神经阻滞可提高甲状旁腺切除术后继发甲状旁腺功能亢进的尿毒症患者的康复质量：一项随机对照试验
超声引导下行双侧颈浅丛神经阻滞可提高甲状旁腺切除术后继发甲状旁腺功能亢进的尿毒症患者的康复质量：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
甲状旁腺切除术是一种降低甲状旁腺激素水平的手术方法。我们评估了超声引导下行双侧颈浅丛神经阻滞（BSCPB）对继发甲状旁腺功能亢进（SHPT）的尿毒症患者甲状旁腺切除术后恢复质量的影响。
将82名接受甲状旁腺切除术并继发甲状旁腺功能亢进的尿毒症患者随机分配到BSCPB组或对照组（CON组）。患者接受超声引导下BSCPB治疗，每侧注射7.5ml浓度为0.5%的罗哌卡因（BSCPB组）或接受等量0.9%的生理盐水（对照组）。主要观察指标包括术前一天和术后第1天（POD1）记录40项恢复质量评分量表（QoR-40）评分。次要观察指标包括瑞芬太尼的总消耗量、首次需要解救性镇痛的时间、需要解救性镇痛的患者人数以及术后24小时内曲马多的总消耗量。评估并记录术后恶心或呕吐（PONV）和视觉模拟评分（VAS）。
在术后第一天的评估结果中，BSCPB组QoR-40的疼痛和情绪状态得分以及QoR-40总分高于CON组（P=0.000）。与对照组相比，BSCPB组的瑞芬太尼总用量明显减少（P=0.000）。与对照组相比，BSCPB组首次需要解救性镇痛的时间更长（P=0.018），需要解救性镇痛的患者更少（P=0.000），术后24小时内曲马多的术后总消耗量更低（P=0.000）。BSCPB组的PONV发生率显著低于CON组（P=0.013）。在术后所有时间点中，BSCPB组的VAS评分均低于CON组（P=0.000）。
超声引导下注射浓度为0.5%的罗哌卡因可提高甲状旁腺切除术后继发甲状旁腺功能亢进的尿毒症患者的恢复质量、术后镇痛效果，并降低PONV的发生率。
Shenghong Hu, Teng Shu, Siqi Xu, et al. Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial.[J]. BMC Anesthesiol(2021) 21:228:1
Ultrasound-guided bilateral superficial cervical plexus block enhances the quality of recovery of uremia patients with secondary hyperparathyroidism following parathyroidectomy: a randomized controlled trial
Abstract
Background: Parathyroidectomy has been proposed as a method for reducing parathyroid hormone levels. We evaluated the effects of ultrasound-guided bilateral superficial cervical plexus block (BSCPB) on the quality of recovery of uremia patients with secondary hyperparathyroidism (SHPT) following parathyroidectomy.
Method:Eighty-two uremia patients who underwent parathyroidectomy and exhibited SHPT were randomly allocated to the BSCPB group or the control group (CON group). The patients received ultrasound-guided BSCPB with 7.5 ml of ropivacaine 0.5% on each side (BSCPB group) or equal amount of 0.9% normal saline (CON group). The primary outcome of the Quality of Recovery-40(QoR-40) score was recorded on the day before surgery and postop-erative day 1(POD1). Secondary outcomes including total consumption of remifentanil, time to first required rescue analgesia, number of patients requiring rescue analgesia, and total consumption of tramadol during the first 24 h after surgery were recorded. The occurrence of postoperative nausea or vomiting (PONV) and the visual analogue scale (VAS) scores were assessed and recorded.
Results:The scores on the pain and emotional state dimensions of the QoR-40 and the total QoR-40 score were higher in the BSCPB group than in the CON group on POD1 (P = 0.000). Compared with the CON group, the total
consumption of remifentanil was significantly decreased in the BSCPB group (P = 0.000). The BSCPB group exhibited longer time to first required rescue analgesia (P = 0.018), fewer patients requiring rescue analgesia (P = 0.000), and lower postoperative total consumption of tramadol during the first 24 h after surgery (P = 0.000) than the CON group. The incidence of PONV was significantly lower in the BSCPB group than in the CON group (P = 0.013). The VAS scores in the BSCPB group were lower than those in the CON group at all time-points after surgery (P = 0.000).
Conclusion:Ultrasound-guided BSCPB with ropivacaine 0.5% can enhance the quality of recovery, postoperative analgesia, and reduce the incidence of PONV in uremia patients with SHPT following parathyroidectomy.