地氟醚用于支撑显微喉镜下声带手术对苏醒的影响  

Desflurane accelerates emergence after self-retaining laryngoscope under the microscope in the surgery of vocal cord

作　　者：刘婷洁 沈霞 李文献 

机构地区：[1]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）》2017年第2期192-195,共4页Fudan University Journal of Medical Sciences

摘　　要：目的观察地氟醚用于支撑显微喉镜下声带手术对复苏的影响。方法 40例ASAⅠ~Ⅱ级择期行支撑显微喉镜下声带手术的成年患者随机分为地氟醚组(D组,n=20)和七氟醚组(S组,n=20)。记录手术结束至自主呼吸恢复时间、拔除气管导管时间和麻醉后恢复室(postanesthesia care unit,PACU)逗留时间;记录两组患者拔管时呛咳反应和拔管后咳嗽事件;记录围手术期各时间点的心率和血压变化:麻醉前(T0)、置入硬喉镜(Tlary)、呼气末吸入麻醉药达1.3 MAC时(T_(1.3mac))、呼气末吸入麻醉药达1.3 MAC后1 min(T_(1.3mac)+1)、送入PACU(T_(pacu))、拔管即刻(Textu)、拔出气管导管后1 min(Textu+1)、5 min(T_(extu+5))和出PACU(Tdis)。结果两组患者自主呼吸恢复时间差异无统计学意义;地氟醚组拔管时间比七氟醚组早4.6 min(P<0.05);地氟醚组PACU逗留时间比七氟醚组晚5 min(P<0.05);地氟醚组拔管时呛咳发生率为100%,高于七氟醚组的55%(P<0.05),拔管后两组间咳嗽事件发生率的差异无统计学意义;两组间围术期血压和心率变化差异无统计学意义。结论地氟醚用于显微喉镜下声带手术利于患者术后快速苏醒,地氟醚组患者拔管时呛咳的发生率高于七氟醚组,但持续时间短暂。Objective To evaluate the effect of desflurane on emergency in patients undergoing suspension microlaryngoscopy surgery. Methods Forty adult patients with ASA Ⅰ-Ⅱ who underwent elective microlaryngoscopy surgery were randomly divided into desflurane group （group D, n=20） and sevoflurane group （group S, n=20）. Time from end of the surgery to resume of spontaneous breathing, extubation, and discharge from postanesthesia care unit （PACU） were recorded. The extent of cough reflex during extubation and cough episode after extubation were recorded. Perioperative mean arterial pressure （MAP） and heart rate （HR） were recorded before anesthesia induction （T0）, on suspension laryngoscope instrument （Tlary）, the gas concentration reached 1.3 MAC （T1.3mac）, 1 min after 1.3 MAC （T1.3mac＋1 ）, on arrival at PACU （Tpacu）, on extubation （Textu）, 1 min after extubation （Textu＋1）, 5 min after extubation （Textu＋5）, and on discharge from PACU （Tdis）. Results Time from end of the surgery to resume of spontaneous breathing was not significantly different between the two groups. Time to extubation in group D was 4.6 min, which was shorter than it was in group S （P〈0.05）. Time to discharge from PACU was 5.0 min in group D, which was shorter than it was in group S （P〈0.05）. Incidence of cough was 100% in group D and 55% in group S during extubation （P〈0.05）. The episode of coughing after extubation was not significantly different between the two groups. Perioperatively, changes of MAP and HR between the two groups were not significantly different （P〉0.05）. Conclusions Desflurane for adult patients undergoing suspension microlaryngoscopy surgery was associated with fast emergence. The incidence of cough was higher in group D than it was in group S during extubation, but it continued a short duration.

关 键 词：显微喉镜手术 声带 地氟醚 麻醉苏醒 并发症 

分 类 号：R614.21[医药卫生—麻醉学]