支撑喉镜下声带息肉摘除术应用瑞芬太尼麻醉的临床观察

Application of anesthesia with remifentanil in excision of polyp of vocal cord under self-retaining laryngoscope

目的 对比观察芬太尼与瑞芬太尼麻醉用于支撑喉镜下行声带息肉摘除术患者的应激反应及患者苏醒情况. 方法 选择86例ASAⅠ～Ⅱ级择期声带息肉摘除术患者,随机均分为两组,即芬太尼组(F组)和瑞芬太尼组(R组).F组诱导及维持麻醉用芬太尼;R组诱导及维持麻醉用瑞芬太尼.两组患者置入支持喉镜成功后,均用喷射呼吸机行常频喷射通气.监测围术期各时点的收缩压(SBP)、舒张压(DBP)、心率(HR)、动脉氧分压(SpO2),记录麻醉时间及患者清醒时间,统计麻醉质量及患者苏醒时的不良反应. 结果 F组放置支持喉镜后SBP、DBP、HR明显升高(P<0.01);清醒时间F组明显长于R组(P<0.01);F组术后恶心、呕吐发生率高于R组(P<0.05). 结论 瑞芬太尼用于声带息肉摘除术患者的麻醉应激反应小,患者苏醒迅速、苏醒时不良反应少.

Objective To compare the patients'stress reaction and palinesthesia of anesthesia with remifentanil and fentanyl in excision of polyp of vocal cord under self-retaining laryngoscope. Methods Eighty-six ASAⅠ-Ⅱ patients scheduled for polyp of vocal cord under self-retaining laryngoscope were randomly divided into two groups: fentanyl group (group F,n=43) and remifentanyl group (group R,n=43).Group F were induced with fentanyl,modazolam,propofol and succinylcholine chloride,maintained with fentanyl,propofol and succinylcholine chloride,while group R with remifentanil instead of fentanyl. The changes of SBP,DBP,MAP,HR, SpO2 were checked at different time point surround the operation. We recorded the anesthetize time and awake time, the quality of the anesthesia and side-effect of palinesthesia.Results The SBP,DBP,MAP and HR of group F were increased obviously after place self-retaining laryngoscope (P<0.01);The recovery time of group F was longer than that of group R (P<0.01);The incidences of postoperative nausea and vomit in group F were slightly higher than those in group R (P<0.05).Conclusions Compared with fentanyl,remifentanil can be used more safely and effectively in polypectomy of vocal cord.