| Objective:In this research, through observing different anesthetic methods in thyroidectomy, evaluating indicators during operation, the effects on stress response can be explored with different anesthetic methods, in order to provide reference and foundation for clinical anesthesia.Methods:40 ASA I-II patients undergoing thyroidectomy were chosen from Yan’an University Affiliated Hospital. They were divided into two groups: Group R/P(remifentanil combined with propofol), and Group N/P(nitrous oxide combined with propofol). During the operation, if blood pressure was less than 90 mm Hg or decreased more than 20 percent of the base values, then injected dopamine,so as to maintain SBP exceeding 90 mm Hg. If the heart rate was less than 50 beats per minute, injected atropine, and the specific dosage shall refer to the base values. The general anesthetic approach consisted of intravenous induction with midazolam 0.05mg/kg, sufentanil 0.5ug/kg, vecuronium 0.1mg/kg and propofol 1mg/kg. Remifentanil or nitrous oxide(N2O) combined with propofol were the maintenance of anesthesia. Vecuronium was administered as boluses attending anesthesiologist. By regulating the concentration of remifentanil or nitrous oxide, the fluctuations of BP and HR were ranged from less than 20 percent to more than 20 percent. After intubation, mechanical ventilation was by Intermittent Positive-Pressure Ventilation.The change of ECG was observed. SBP, DBP and HR were recorded at the time of 10 minutes after entering the operating room(T0), immediate after intubation(T1), before skin incision(T2), skin incision after 1 minute(T3), thyroid separation(T4) and end of surgery(T5). The values of blood glucose, cortisol and C-reactive protein(CRP) were monitored at each time of T0, T3 and T4 with 3ml peripheral venous blood.Outcomes:1. SBP: During operation, SBP in Group R/P at T2(109.50±10.76 mm Hg) was lower than T0(115.55±12.93 mm Hg), the difference had statistical significance(P=0.023<0.05). SBP in Group N/P at T4(126.05±8.72 mm Hg) was higher than T0(117.80±12.27 mm Hg), the difference had statistical significance(P=0.014<0.05).2. DBP: DBP was compared between two groups and in its own group, the difference was not statistically significant(P >0.05).3. HR: Compared heart rate between T4(83.70±7.47 beats/min) and T0(76.70 ±9.44 beats/min) in Group N/P, the heart rate at T4 was higher than T0, the difference was obviously statistically significant(P=0.003<0.01).4. Cortisol: Compared cortisol between Group R/P and Group N/P at each point of T0, T3 and T4, cortisol at T0 of two groups(211.59±34.65 nmol/L vs. 228.34±26.09 nmol/L) had no statistical significance(P=0.535 > 0.05). Compared between T3(229.96±37.64 nmol/L) in Group R/P and T3(394.54±63.14 nmol/L) in Group N/P, cortisol in Group R/P was lower than in Group N/P, the difference had statistical significance(P=0.012<0.05). Compared between T4(303.76±33.70 nmol/L) in Group R/P and T4(497.32±54.93 nmol/L) in Group N/P, cortisol in Group R/P was lower than in Group N/P, the difference had statistical significance(P=0.034<0.05). Each group of patients was compared cortisol between T3, T4 and T0 in its own group. In Group R/P, compared cortisol between T3(229.96±37.64 nmol/L) and T0(211.59±34.65 nmol/L), T3 was higher than T0, so the difference had obviously statistical significance(P<0.01). In Group R/P, T4(303.76±33.70 nmol/L) was higher than T0(211.59±34.65 nmol/L), then, the difference had obviously statistical significance(P<0.01). In Group N/P, compared cortisol between T3(394.54±63.14 nmol/L) and T0(228.34±26.09 nmol/L), T3 was higher than T0, the difference had obviously statistical significance(P<0.01). In Group R/P, T4(228.34±26.09 nmol/L) was higher than T0(211.59±34.65 nmol/L), the difference had obviously statistical significance(P<0.01).5. Blood Glucose: Compared blood glucose between Group R/P and Group N/P at each point of T0, T3 and T4, blood glucose at T0 of two groups(4.21±0.22 mmol/L vs. 4.18±0.22 mmol/L) had no statistical significance(P=0.685>0.05). Compared between T3(5.31±0.37 mmol/L) in Group R/P and T3(5.79±0.50 mmol/L) in Group N/P, blood glucose in Group R/P was lower than in Group N/P, the difference had statistical significance(P=0.040<0.05). Compared between T4(6.20±0.26 mmol/L) in Group R/P and T4(6.78±0.60 mmol/L) in Group N/P, blood glucose in Group R/P was lower than in Group N/P, the difference had obviously statistical significance(P=0.002<0.01). Each group of patients was compared blood glucose between T3, T4 and T0 in its own group. In Group R/P, compared blood glucose between T3(5.31±0.37 mmol/L) and T0(4.21±0.22 mmol/L), T3 was higher than T0, so the difference had obviously statistical significance(P<0.01). In Group R/P, T4(6.20±0.26 mmol/L) was higher than T0(4.21±0.22 mmol/L), then, the difference had obviously statistical significance(P<0.01). In Group N/P, compared blood glucose between T3(5.79±0.50 mmol/L) and T0(4.18±0.22 mmol/L), T3 was higher than T0, the difference had obviously statistical significance(P<0.01). In Group R/P, T4(6.78±0.60 mmol/L) was higher than T0(4.18±0.22 mmol/L), the difference had obviously statistical significance(P<0.01).6. C-Reaction Protein(CRP): Compared CRP between Group R/P and Group N/P at each point of T0, T3 and T4, CRP at T0 of two groups(11.01±4.29 mg/L vs. 10.60±4.72 mg/L) had no statistical significance(P=0.785 > 0.05). Compared between T3(22.57±5.94 mg/L) in Group R/P and T3(28.36±10.85 mg/L) in Group N/P, CRP in Group R/P was lower than in Group N/P, the difference had statistical significance(P=0.037<0.05). Compared between T4(35.64±7.86 mg/L) in Group R/P and T4(45.09±4.29 mg/L) in Group N/P, CRP in Group R/P was lower than in Group N/P, the difference had statistical significance(P=0.029<0.05). Each group of patients was compared CRP between T3, T4 and T0 in its own group. In Group R/P, compared CRP between T3(22.57±5.94 mg/L) and T0(11.01±4.29 mg/L), T3 was higher than T0, so the difference had obviously statistical significance(P<0.01). In Group R/P, T4(35.64±7.86 mg/L) was higher than T0(11.01±4.29 mg/L), the difference had obviously statistical significance(P<0.01). In Group N/P, compared CRP between T3(28.36±10.85 mg/L) and T0(10.60±4.72 mg/L), T3 was higher than T0, then, the difference had obviously statistical significance(P<0.01). In Group R/P, T4(45.09±4.29 mg/L) was higher than T0(10.60±4.72 mg/L), the difference had obviously statistical significance(P<0.01).Conclusions:1. Remifentanil combined with propofol in thyroidectomy stabilizes hemodynamics,and inhibits stress response to a greater degree.2. In thyroidectomy, total intravenous anesthesia(propofol combined wih remifentanil) is better than intravenous and inhalation anesthesia(propofol combined with nitrous oxide). |
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