2024 年第 4 期 第 19 卷

依托咪酯靶控输注联合喉返神经功能监测在腔镜甲状腺手术中的应用效果分析

Analysis of etomidate target-controlled infusion combined with recurrent laryngeal nerve function monitoring in endoscopic thyroid surgery

作者：龙乾海骆喜宝张旭陆敏秦炳兰米巧巧

英文作者：Long Qianhai Luo Xibao Zhang Xu Lu Min Qin Binglan Mi Qiaoqiao

单位：桂林医学院第二附属医院麻醉科，桂林541199

英文单位：Department of Anesthesiology the Second Affiliated Hospital of Guilin Medical University Guilin 541199 China

关键词：腔镜甲状腺手术；靶控输注；依托咪酯

英文关键词：Endoscopicthyroidectomy;Target-controlledinfusion;Etomidate

• 摘要：

• 目的 探讨依托咪酯靶控输注联合喉返神经功能监测在腔镜甲状腺手术中的应用效果。方法 选取2020年12月至2022年12月于桂林医学院第二附属医院确诊并在喉返神经功能监测下进行腔镜甲状腺手术治疗的80例甲状腺癌患者为研究对象，按照随机数字表法分为观察组和对照组，各40例。观察组予依托咪酯靶控输注，对照组予丙泊酚靶控输注，气管插管后行机械通气，同时2组均监测喉返神经功能。记录患者手术时间及术后苏醒时间、停药至拔管时间。记录2组麻醉诱导前（T0）、麻醉诱导时（T1）、气管插管完成后即刻（T2）平均动脉压（MAP）、心率和脑电双频指数（BIS）及术后不良反应发生情况。结果 观察组术后苏醒时间、停药至拔管时间均短于对照组［（17±4）min比（20±4）min、（13.1±2.5）min比（20.2±2.9）min］（均P<0.001）。T1、T2时点2组MAP、心率、BIS均低于T0时点，但观察组均高于对照组（均P<0.001）。2组术后不良反应发生率比较差异无统计学意义（P=0.166）。结论 依托咪酯靶控输注联合喉返神经功能监测在腔镜甲状腺手术中具有较好的应用效果，不仅能够缩短术后苏醒时间与停药至拔管时间，同时可保持术中血流动力学稳定。

• Objective To explore the effect of etomidate target-controlled infusion combined with recurrent laryngeal nerve function monitoring in endoscopic thyroid surgery. Methods Totally 80 patients diagnosed and underwent endoscopic thyroid surgery in the Second Affiliated Hospital of Guilin Medical University from December 2020 to December 2022 were enrolled. According to the random number method, patients were divided into observation group and control group, with 40 cases in each group. The observation group was given target-controlled infusion of etomidate, and the control group was given target-controlled infusion of propofol. Mechanical ventilation was performed after endotracheal intubation. Meanwhile, recurrent laryngeal nerve function was monitored in both groups. The operation time, postoperative recovery time, time from drug withdrawal to extubation of patients were recorded. Mean arterial pressure (MAP), heart rate and bispectral index (BIS) before anesthesia induction (T0), tracheal intubation (T1) and immediately after tracheal intubation (T2) and adverse reactions after operation were recorded. Results The recovery time and the time from drug withdrawal to extubation in the observation group were shorter than those in the control group ［（17±4）min vs （20±4）min,（13.1±2.5）min vs （20.2±2.9）min］（both P<0.001）. At T1 and T2, MAP, heart rate and BIS in both groups were lower than those at T0, and the levels in the observation group were higher than those in the control group (all P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.166). Conclusions Etomidate target-controlled infusion combined with recurrent laryngeal nerve function monitoring has a good application effect in endoscopic thyroid surgery. It can not only shorten the postoperative recovery time and the time from drug withdrawal to extubation, but also maintain intraoperative hemodynamic stability.