瑞芬太尼联合异丙酚靶控输注技术用于支撑喉镜手术的临床研究

Target-controlled infusion of remifentanil and propofol during operation with suspension laryngoscopy

目的:评价瑞芬太尼异丙酚靶控输注静脉麻醉用于支撑喉镜下手术的临床可行性,并比较瑞芬太尼异丙酚靶控输注静脉麻醉和枸橼酸芬太尼异氟烷静吸复合麻醉的应用.方法:ASAⅠ～Ⅱ级耳鼻喉科支撑喉镜手术患者60例,随机分成2组:TCI组麻醉诱导时设定瑞芬太尼血浆靶浓度6 μg/L、异丙酚血浆靶浓度3 mg/L,术中靶浓度维持不变,术毕停药;对照组麻醉诱导以异丙酚1～2 mg/kg、枸橼酸芬太尼2.5 μg/kg静注,术中吸入1%异氟烷和静注芬太尼0.03 μg.kg-1.min-1维持麻醉,术毕停止.记录2组各时段生命指征(血压、心率、氧饱和度),麻醉恢复情况(自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间和离开恢复室时间),术中不良事件的发生和药物使用情况,观察患者拔管后即刻、离开恢复室(PACU)、拔管后30 min、1 h和3 h的意识状态(OAAS)、术后并发症和满意度.结果:①术中TCI组瑞芬太尼血药浓度维持在6 μg/L、异丙酚血药浓度维持在3 mg/L的给药速度,血流动力学稳定;②在行气管插管、支撑喉镜置入、拔管前对照组的平均动脉压(MAP)明显高于TCI组,有统计学差异;③自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间和离开PAC时间TCI组早于对照组;④TCI组在拔管后即刻、离开PACU、拔管后30 min、1 h OAAS评分高于对照组;⑤2组患者一般情况、术中不良事件的发生情况和术后并发症、患者满意度差异无显著性.结论:与常规静吸复合麻醉下行支撑喉镜手术相比,瑞芬太尼异丙酚靶控输注静脉麻醉更平稳,苏醒更快,更适用.

Objective： To evaluate target-controlled infusion （TCI） of remifentail-propofol and the balanced anesthesia of fentanyl-isoflurane during the operation with suspension laryngscope. Methods： Sixty ASA Ⅰ～Ⅱ patients scheduled for the surgery through suspension laryngoscopy were randomly divided into two groups：TCI group and control group. In TCI group, anesthesia was maintained with TCI remifentanil-propofol which was stopped at the end of operation. The target plasma concentration of remifentanil was set at 6 /Lg/L and propofol at 3 mg/L. In control group,anesthesia was induced with intravenous fentanl 2. 5 μg/kg and propofol 1-2 mg/kg, maintained with fentanl 0.03μg·kg^-1. min^-1 and 1% isoflurane which was stopped at the end of surgery. Intubation was facilitated with succinylcholine 1 - 1. 5mg/kg. MAP, HR, ECG, SpO2 and PETCO2 were monitored during anesthesia. The following parameters were recorded and compared between two groups ： （1） the changes in blood pressure （BP）, heart rate （HR） and SpO2 at different time point; （2） recovery profile including the time of response to verbal commands, autonomous breathing, tracheal extubation,orientation recovery,discharglng from PACU after operation; （3） OAAS scores after operation; （4） postoperative complications; （5） unexpected events and awareness during operation. Results： （1） The hemodynamics were stable while the target plasma concentration of remifentanil was set at 6μg/L and propofol at 3mg/L. （2） During tracheal intubation,suspension laryngoscope was inserted, and extubation MAP was significantly lower in TCI group than that in control group; （3） There were no significant differences in hemodynamic values and SpO2 of different time points between two groups. Study group was faster than control group on recovery profile including the time of response to verbal commands, autonomous breathing, tracheal extubation, orientation recovery and discharging from PACU. There was respectively one unexpected event in both groups. Conclusion： Remifentanil supplemented with isoflurane anesthesia can achieve the optimal hemodynamic stability during the operation with suspension laryngoscopy and better recovery profile from anesthesia than fentanyl.