短小支撑喉镜手术全静脉靶控输注麻醉与静吸复合麻醉效果比较  

A comparison of total intravenous anesthesia with propofol and remifentanil by TCI and inhalation-intravenous balanced anesthesia in patients undergoing short suspensive laryngoscope surgery

作　　者：满元元[1] 杨静[1] 姜雨鸽[1] 徐龙和[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《武警医学》2009年第5期435-438,共4页Medical Journal of the Chinese People's Armed Police Force

基　　金：国家自然科学基金项目(编号:30300327)

摘　　要：目的观察和对比全静脉靶控输注麻醉和静吸复合麻醉在短小支撑喉镜手术的麻醉效果。方法择期短小支撑喉镜手术患者40例随机分为2组:全静脉靶控输注麻醉组(A组)和静吸复合麻醉组(B组),每组20例。均采用镇痛健忘慢诱导经鼻气管插管,A组靶控输注异丙酚、瑞芬太尼维持;B组持续吸入七氟醚和静推芬太尼维持。术中维持相对恒定麻醉深度。观察记录围术期不同时点的血流动力学变化、术后麻醉恢复时间和质量等。结果B组置入支撑喉镜时及置入喉镜后3 min血流动力学变化明显高于A组;与基础值比较,差异有统计学意义(P<0.05)。A组术后麻醉恢复时间明显短于B组(P<0.05)。结论瑞芬太尼复合异丙酚全静脉靶控输注麻醉,麻醉深度易于调控,在术中置入支撑喉镜等强烈刺激时可维持血流动力学稳定、有效抑制应激反应,术后苏醒迅速且恢复质量高。Objective To investigate the effects of total intravenous anesthesia with propefol and remifentanil by target controlled infusion （TCI） in patients undergoing short suspensive laryngoscope surgery. Methods Forty patients scheduled for suspensive laryngoscope surgery were randomly divided into two groups （n = 20 each） ：total intravenous TCI anesthesia group （group A） and inhalation -intravenous balanced anesthesia group （group B）. In all patients, anesthesia was induced with fentanyl/midazolam followed by topical anesthesia of larynopharynx with 2% dicaine and nasotracheal intubation. TCI with propofol and remifentanil was used in group A,wbere as sevoflurane combined with intravenous injection of fentanyl was used in group B. The bispeetral index was kept between 50 and 60. MAP and HR were recorded at different time points during the perioperative period. The time of eye - opening, extubation and recovery profile were recorded. Results The patients in group B experienced significant increases of HR and MAP at the time of inserting suspensive laryngoscope and 3 rains after insertion of suspensive laryngoscope. The time from termination of anesthetic administration to eye opening and tracheal extubation in group A was significantly shorter than that in group B. Conclusions Total intravenous anesthesia with propofol and remifentanil by TCI offers better anesthetic effect and prognosis in suspensive laryngoscope surgery.

关 键 词：全静脉麻醉 靶控输注 瑞芬太尼 异丙酚 支撑喉镜 

分 类 号：R614.21[医药卫生—麻醉学] R614.24[医药卫生—外科学]