瑞芬太尼复合异丙酚在显微喉镜下声带手术的应用  

The use of remifentanil combined propofol during voca-cord operation with microlaryngoscopy

作　　者：沈霞[1] 陈英子[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031

出　　处：《复旦学报（医学版）》2007年第1期129-131,共3页Fudan University Journal of Medical Sciences

摘　　要：目的比较瑞芬太尼复合异丙酚与传统平衡麻醉对显微喉镜下声带手术血流动力学及苏醒质量的影响。方法按美国麻醉医师协会分级标准（American Standard of Anesthesia，ASA）Ⅰ～Ⅱ级，80例择期行显微喉镜下声带手术的病人随机分为瑞芬太尼组（R组）和平衡麻醉组（I组）。R组病人瑞芬太尼1μg／kg，异丙酚2mg／kg，司可林1．5mg／kg麻醉诱导后瑞芬太尼0．2～0．5μg·kg^-1·min^-1，异丙酚50～75μg·kg^-1·min。持续静脉滴注；Ⅰ组病人芬太尼3μg／kg，异丙酚2mg／kg，司可林1．5mg／kg麻醉诱导后2％～3％异氟醚吸入。20～40mg司可林静脉推注维持肌松。麻醉期间监测平均动脉压（mean arterial pressure，MAP），心率（heartrate，HR），ECG，SPO2和呼气末二氧化碳（endtidal CO2，ETCO2）。观察指标（1）2组病人麻醉前、麻醉诱导后、气管插管后、放置支撑喉镜后的MAP，HR，ECG，SPO2；（2）麻醉复苏情况如拔除气管导管、定向力恢复时间；（3）有无术中知晓及术后并发症等。结果（1）血流动力学变化R组较平稳。（2）R组病人术后恢复优于Ⅰ组。（3）术中无知晓、术后无明显不良并发症。结论瑞芬太尼复合异丙酚较平衡麻醉用于显微喉镜下声带手术血流动力学平稳、且无术中知晓、术后恢复快。Purpose To evaluate remifentanil combined propofol and the balanced anesthesia of fentanyl-isoflurane during the vocal-cord operation with microlaryngoscopy. Methods Eighty ASA Ⅰ - Ⅱ patients scheduled for the surgery by microlaryngoscopy were randomly divided into 2 groups： R group and Ⅰ group. In R group, patients were anesthetized with 2 mg/kg propofol iv and 1ug/kg remifentanil iv followed by a continous infusion of 0.2 - 0.5 μg · kg^-1· min^-1. In I group, anesthesia was induced with intravenous fentanl 3 ug/kg and propofol 2 mg/kg, maintained with 2 % - 3 % isoflurane. Musclerelax was facilitated with succinylcholine 20- 40 mg iv. MAP, HR, ECG, SPO2 and ETCO2 were mo- nitored during anesthesia. The following parameters were recorded and compared between 2 groups： （1） MAP, HR, EKG and SPO2 at different time point; （2） recovery profile including the time of tracheal extubation and orientation recovery after operation; （3） awareness during operation and postoperative complications. Results （1） The hemodynamics were stabler in group R; （2） Group R was faster than group I on recovery profile; （3）There was no awareness and other complications in both groups. Conclusions Remifentanil combined propofol can achieve the optimal hemodynamic stability during the operation with microlaryngoscopy and better recovery profile from anesthesia.

关 键 词：瑞芬太尼 手术 显微喉镜 声带病变 

分 类 号：R762[医药卫生—耳鼻咽喉科]