射频消融辅助上气道手术患者瑞芬太尼、异丙酚联合局部麻醉的效果  

Efficacy of remifentanil and propofol combined with local anesthesia for coblation-assisted upper-airway procedures

作　　者：周大春[1] 张运龙[1] 侯铁宁[2] 

机构地区：[1]浙江大学医学院附属邵逸夫医院麻醉科,杭州市310016 [2]浙江大学医学院附属邵逸夫医院耳鼻喉科,杭州市310016

出　　处：《中华麻醉学杂志》2008年第8期695-697,共3页Chinese Journal of Anesthesiology

基　　金：浙江省卫生厅科研基金资助项目（20088112）

摘　　要：目的评价射频消融辅助上气道手术（CAUP）患者瑞芬太尼、异丙酚联合局部麻醉的效果。方法拟在局麻下行CAUP手术的中、重度阻塞性睡眠呼吸暂停低通气综合征患者80例，年龄25～60岁，体重指数≤35kg／m2，ASAⅠ或Ⅱ级，随机分为4组（n=20）：生理盐水组（S组）、异丙酚组（P组）、瑞芬太尼组（R组）和异丙酚复合瑞芬太尼组（PR组）。1％丁卡因咽部表面麻醉后，S组静脉输注生理盐水0．15ml·kg^-1·h^-1，P组静脉输注异丙酚25μg·kg^-1·min^-1，R组静脉输注瑞芬太尼0．05μg·kg^-1·min^-1，PR组静脉输注异丙酚25μg·kg^-1·min^-1和瑞芬太尼0．05μg·kg^-1·min^-1。10min后用含1：200000肾上腺素的利多卡因行术野局部浸润麻醉。术中每5分钟采用Ramsay评分评价镇静程度；采用主诉疼痛分级（VRS）评价疼痛程度。S组VRS分级为Ⅲ级时为麻醉失败，其余3组VRS分级为Ⅲ级时，增加输注速率或静脉注射异丙酚10mg或瑞芬太尼20μg；如出现Ramsay评分〉3分或呼吸抑制（RR〈8次／min或spO2〈95％），则为麻醉失败。于射频消融前和射频消融5min时记录BP和HR。记录气道阻塞和呼吸暂停等不良反应的发生情况。结果R组、PR组麻醉成功率（分别为90％、100％）高于S组和P组（分别为40％、65％）（P〈0．05）。与S组比较，射频消融5min时P组SP、DP和HR差异无统计学意义（P〉0．05），R组和PR组SP、DP和HR降低（P〈0．05）。4组不良反应发生率比较差异无统计学意义（P〉0．05）。结论瑞芬太尼和异丙酚复合瑞芬太尼联合局部麻醉可安全、有效地用于患者射频消融辅助上气道手术。Objective To evaluate the efficacy and safety of remifentanil and propofol combined with local anesthesia for coblation-assisted upper-airway procedure （CAUP）. Methods Eighty ASA Ⅰ or Ⅱ patients aged 25-60 yr body mass index ≤ 35 kg/m2 with sleep apnea hypopnea syndrome scheduled for CAUP were randomly divided into 4 groups （ n = 20 each） ： normal saline group （S）, propofol group （P）, remifentanil group （R） and propofol ＋ remifentanil group （PR）. After topical anesthesia with 1% decicaine, the patients in group S, P, R or PR received iv infusion of normal saline 0.15 ml·kg^- 1· h^- 1 , propofol 25 μg·kg^-1·min^-1 , remifentanil 0.05 μg·kg^-1·min^-1, or propofol ＋ remifentanil at the same rate respectively. Ten minutes later local infiltration anesthesia was performed in operative field with lidocaine containing epinephrine 1 ： 200 000. Ramsay sedation score and verbal rating scale （VRS） were assessed every 5 min. VRS Ⅲ was defined as anesthesia failure in group S. It was also defined as anesthesia failure that Ramsay sedation score 〉 3 or occurrence of respiratory depression during increment of propofol or remifentanil in patients with VRS m in the other 3 groups. BP and HR were recorded before coblation and 5 min after coblation. Airway obstruction and apnea were also observed. Results Anesthesia achievement ratio was significantly higher in group R and PR （90% and 100% respectively） than in group S and P （40% and 65% respectively） （P 〈 0.05）. SP, DP and HR were significantly lower 5 min after coblation in group R and PR than in group S （ P 〈 0.05） . There was no significant difference in incidence of adverse effects between the 4 groups （ P 〉 0.05 ）. Conclusion Remifentanil or propofol-remifentanil combined with local anesthesia is safe and effective for CAUP.

关 键 词：哌啶类 二异丙酚 麻醉药 局部 

分 类 号：R614[医药卫生—麻醉学]