鼻内镜手术无肌松药全身麻醉可行性探讨  

Application of general anesthesia without muscle relaxant in nasal endoscopic surgery

作　　者：杨戈雄[1] 袁杰[2] 高爽[1] 李滔[1] 滕煜[1] 马军令[1] 

机构地区：[1]武警新疆总队医院麻醉科,乌鲁木齐830091 [2]武警新疆总队医院泌尿外科,乌鲁木齐830091

出　　处：《武警医学》2014年第12期1199-1201,1204,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨在无肌松药全麻下行鼻内镜手术的可行性。方法将120例ASAⅠ～Ⅱ级择期行鼻内镜手术的患者随机分成常规肌松药组（Ⅰ组）及无肌松药插管维持组（Ⅱ组）各60例。Ⅰ组予维库溴铵0.08～0.1 mg/kg诱导,在患者有体动时,或每40 min静脉注射0.05 mg/kg维持肌松;Ⅱ组在复合气道充分表面麻醉后行气管插管,术中无肌松药维持。记录两组麻醉前（T0）、麻醉诱导后2 min（T1）、气管插管后2 min（T2）、手术开始后2 min（T3）、手术开始后20 min（T4）、拔管后5 min（T5）各时点的血压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（Pet CO2）,比较两组术中体动次数、麻醉苏醒及拔管时间、不良反应、并发症,以及术中追加输注瑞芬太尼、丙泊酚的用药量。结果两组T1时点MAP、HR较T0均有下降（P〈0.05）,T2与T0比较差异无统计学意义（P〉0.05）;Ⅱ组T3时点MAP较T0上升,与Ⅰ组比较差异有统计学意义（P〈0.05）;Ⅰ、Ⅱ组术后命令反应时间[（9.0±2.4）min vs（2.1±1.2）min]、拔管时间[（15.1±3.6）min vs（3.5±1.6）min]、离室时间[（25.5±8.2）min vs（5.6±2.7）min]比较,Ⅰ组长于Ⅱ组,差异有统计学意义（P〈0.01）。结论无肌松药气管插管全麻下实施鼻内镜手术麻醉效果可靠,安全可行。Objective To investigate the effect and feasibility of anesthesia without muscle relaxant in nasal endoscopic operation. Methods 120 patients with ASA Ⅰ-Ⅱundergoing nasal endoscopic operation were randomly divided into normal muscle relaxant use group（ group Ⅰ） and intubation without muscle relaxant maintenance group（ groupⅡ）,60 cases in each. Group Ⅰ was treated with vecuronium 0. 08-0. 1 mg / kg induced,in patients with body movement or per 40 min intravenous infusion of 0. 05 mg / kg maintaining muscle relaxation; group Ⅱtracheal intubation after complex full airway surface anesthesia but without muscle relaxants maintenance during operation. Blood pressure（ MAP）,heart rate（ HR）,pulse oxygen saturation（ SpO2）,end tidal carbon dioxide partial pressure（ Pet CO2） were recorded in each time point in the two groups before anesthesia（ T0）,2 min after anesthesia induction（ T1）,2 min after endotracheal intubation（ T2）,2 min after the start of operation（ T3）,20 min after the start of operation（ T4）,and 5 min after extubation（ T5）. The body movement frequency intraoperation,recovery time from anesthesia and extubation time,adverse reactions and complications and intraoperative additional infusion dosage of remifentanil and propofol were compared between the two groups. Results In both groups,T0～ T4 each observation point,HR,MAP,SpO2 and Pet CO2 changes were not significantly different（ P〉0. 05）. Breathing the air after 5 min（ T5）,SPO2 in group Ⅱ were higher than those in group Ⅰ,Pet CO2 in groupⅡlower than that in group Ⅰ,there were significant differences between the two groups（ P〈0. 05）. In group Ⅱ,anesthesia recovery time and extubation time were significantly shorter than those in group Ⅰ（ P〈0. 01）. There were no adverse reaction and complication.Conclusions The effect of nasal endoscopic surgery under tracheal intubation general anesthesia without muscle relaxant is reliable,safe and feasible.

关 键 词：无肌松药 气管插管 全身麻醉 鼻内镜手术 

分 类 号：R614.21[医药卫生—麻醉学]