支撑喉镜下声带新生物摘除术的临床麻醉方式探讨  

A Clinical Study on Anesthesia in the Suspensive Laryngoscopy Vocal Neoplasm Enucleation

作　　者：谷思汉[1] 

机构地区：[1]湖南省马王堆医院麻醉科,410016

出　　处：《医学研究杂志》2009年第6期97-99,共3页Journal of Medical Research

摘　　要：目的比较丙泊酚与瑞芬太尼或芬太尼全凭静脉麻醉在支撑喉镜声带新生物摘除术中的临床效果。方法ASAⅠ～Ⅱ级择期声带新生物手术病人60例,随机分成组Ⅰ与组Ⅱ,每组30例。组Ⅰ依次静脉注入异丙酚2mg/kg、芬太尼4μg/kg、维库溴胺0.1mg/kg进行麻醉诱导。组Ⅱ依次静脉注入异丙酚2mg/kg、瑞芬太尼1μg/kg、维库溴胺0.1mg/kg进行麻醉诱导。两组均经鼻气管插管连接麻醉机机械通气。麻醉维持两组均采用持续静脉泵入异丙酚2～3mg(kg·h)+瑞芬太尼0.05μg/(kg.min)。观察两组支撑喉镜置入前后、气管插管时及术中的血压心率变化;术毕停药后病人自主呼吸恢复时间t1、清醒拔管时间t2、患者停药后1min、2min、3min、4min、5min时镇静程度(改良OAA/S法)。结果两组患者一般情况比较无明显差异(P>0.05)。支撑喉镜置入后,组Ⅰ患者收缩压、舒张压、心率均明显升高(P<0.05,P<0.01),组Ⅱ患者仅收缩压表现明显升高;组Ⅰ患者收缩压和舒张压均明显高于组Ⅱ患者(P<0.05)。组Ⅰ患者苏醒时间略长于组Ⅱ。患者OAA/S评分(P<0.05),组Ⅱ停药后3min、4min、5min明显高于组Ⅰ(P<0.05)。恢复自主呼吸时间t1,清醒拔管时间t2组Ⅱ明显短于组Ⅰ(P<0.01)。两组患者苏醒期躁动方面无明显差异。结论丙泊酚-瑞芬太尼全凭静脉麻醉用于支撑喉镜声带新生物摘除术可获得良好的麻醉效果。Objective To compare the effect of different anesthetic as remifentanil and fentanyl propofol on suspensive laryngoscopy vocal neoplasm enucleation. Methods Sixty patients undergone mierolaryngeal surgery were randomly divided into two groups （30 cases in each group）. The propofol of 2mg/kg, fentanyl 4 μg/kg, vecuronum 0.1 mg/kg in group Ⅰ , and 2mg/kg, remifentanil 1 μg/kg,vecurohum 0.1 mg/kg in group Ⅱ was intravenous during induction in order. Then patients used nasal intubation and mechanical ventilated by the anesthesia machine in both groups. At last, the propofol of 2 -3 （mg/kg · h） ,remifentanil 0. 05μg/（ kg · min） being continous intravenous in the anesthesia was maintained in both groups. Record the data of each group, including base data, after conducting, endotracheal intubation, before implantated the suspensive laryngoscopy, after implantated the suspensive laryngoscopy. Record the time of each group about their recovered spontaneous respiration （ t1 ） , conscious extubation （ t2 ） and sedation scale （OAA/S） in 1 , 2,3,4,5, minutes after stopping treating. Results There is no significant difference between two groups about the general condition （ P 〉 0. 05）. There was significantly increased HR, SBP, DBP after implantated the suspensive laryngoscopy in group Ⅰ （P 〈 0.05 ,P 〈 0. 01 ） , but only SBP that was significantly increased in The Group Ⅱ . t1 and t2 in group H was significantly shorter than those in group Ⅰ （ P 〈 0. 01 ）. The OAA/S in group Ⅱ in the 3,4,5, minutes after stopping treating was significantly higher than those in group Ⅰ （ P 〈 0.05 ）. Conclusion The propofol and remifentanil total intravenous anesthesia has significant effect on the suspensive laryngoscopy vocal neoplasm enucleation.

关 键 词：瑞芬太尼 芬太尼 丙泊酚 支撑喉镜 

分 类 号：R767.91[医药卫生—耳鼻咽喉科] R169.42[医药卫生—临床医学]