摘要目的 探讨术前在超声引导下行星状神经节阻滞(S GB)对甲状腺术后头痛、恶心呕吐发生率的影响.方法 90例行常规甲状腺手术的患者按抽签的方法分为三组,每组30例:L组,麻醉诱导后用5 ml 0.5%利多卡因行SGB;N组,麻醉诱导后用5 ml 0.9%氯化钠行SGB;C组不做任何阻滞.术后48 h观察并记录患者术后头痛、恶心呕吐发生率、程度及不适感等.术后头痛、恶心呕吐用口头评定量表(VRS)进行评价.比较L组和N组SGB前后颈总动脉和椎动脉血流动力学变化;比较对照组平卧位与甲状腺手术体位颈总动脉和椎动脉的血流动力学变化.结果 N组和C组各有1例排除本研究.在术后48 h内,L组头痛发生5例(16.7%),N组8例(27.6%),C组17例(58.6%),C组头痛发生率显著高于L组(P=0.0007).三组头痛多发生在术后2、4 h.在术后48 h内,L组恶心呕吐发生8例(26.7%),N组11例(37.9%),C组20例(69.0%),C组恶心呕吐发生率显著高于L组(P=0.0017)和N组(P=0.0343).三组恶心呕吐多发生在术后2、4 h.在L组与N组,行SGB后椎动脉与颈总动脉内径增宽(P<0.05).在C组,甲状腺手术体位时椎动脉与颈总动脉的内径比平卧位时变窄(P<0.05).SGB过程中未见并发症.结论 术前用0.5%利多卡因5 ml行SGB可有效减低甲状腺术后头痛、恶心呕吐的发生率.

abstractsObjective To explore the effect of ultrasound-guided stellate ganglion block (SGB) in the incidence of postoperative headache, nausea and vomiting in conventional thyroidectomy. Methods Ninety patients undergoing conventional thyroidectomy were randomly allocated to three groups with 30 patients in each group. In group L, SGB was performed with 5 ml 0.5% lidocaine; in group N, SGB was performed with 5 ml 0.9% sodium chloride; and in group C, no prior block was performed. Postoperatively, during the 48 h after surgery, every episode of postoperative headache and postoperative nausea and vomiting was recorded and a safety assessment was performed. In group L and group N, the hemodynamic status of the vertebral artery and carotid artery was recorded before and after the SGB was performed. In group C, the hemodynamic status of the vertebral artery and carotid artery was recorded before and after the neck was in the full extension position. Results One patient of group N and one patient of group C was discharged. During the 48 h after surgery, headache occured in 5 patients (16.7%) of group L, 8 patients (27.6%) of group N, and 17 patients (58.6%) of group C, and the headache rate in group C was significantly higher than that in group L (P=0.0007). The headache mostly occurred at 2 h and 4 h after operation. During the 48 h after surgery, nausea and vomiting occured in 8 patients (26.7%) of group L, 11 patients (37.9%) of group N, and 20 patients (60.9%) of group C, and the nausea and vomiting rate in group C was significantly higher than that in group L (P=0.0017) and group N (P=0.0343). The nausea and vomiting mostly occurred at 2 h and 4 h after operation.In group L and group N, and the inner diameters of the vertebral and carotid arteries after SGB were wider than those before SGB (P<0.05). In group C, the inner diameters of the vertebral and carotid arteries after the neck extension position were narrower than prostration position (P<0.05). No side effects were observed during or after SGB. Conclusions Preoperative SGB performed with 5 ml 0.5%lidocaine is an effective technique for reducing postoperative headache and nausea and vomiting after thyroidectomy.