全静脉麻醉和平衡麻醉对支撑喉镜声带手术应激反应影响的比较

Compare effects of total intravenous anesthesia and balanced anesthesia on stress response on suspensive laryngoscope vocal cords surgery

目的：观察和比较全静脉麻醉和平衡麻醉对支撑喉镜声带手术应激反应的影响。方法：选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级择期行声带手术患者30例，随机分为2组：全静脉麻醉组（TIVA组）和平衡麻醉组（BAL组），每组15例。两组均采用镇痛健忘慢诱导。麻醉维持：TIVA组以异丙酚、瑞芬太尼和司可林维持；BAL组以芬太尼、异氟醚和司可林维持。观察记录麻醉诱导前、诱导后插管前、插管即刻、插管后3min、置入支撑喉镜时、置入支撑喉镜后3min各时点的平均动脉压（MAP）、心率（HR）变化；记录自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间、离开恢复室（PACU）时间。测定诱导前、插管时、置镜时及置镜后3min血中肾上腺素（E）、去甲肾上腺素（NE）、皮质醇及白介素．6（IL-6）浓度。结果：插管时循环无较大波动，血中E、NE、皮质醇及IL-6浓度与诱导前差异无统计学意义（P〉0．05）。置镜时及置镜后3min MAP、HR以及血中E、NE、皮质醇及IL-6均高于诱导前，也明显高于TIVA组；而TIVA组与诱导前差异无统计学意义（P〉0．05）。TIVA组自主呼吸恢复时间、呼之睁眼时间、拨管时间明显短于BAL组（P〈0．05）。结论：采用镇痛健忘慢诱导经鼻气管插管，瑞芬太尼-异丙酚全静脉麻醉维持，可以有效抑制气管插管和置入支撑喉镜引起的血流动力学剧变和应激反应，苏醒迅速，在支撑喉镜下声带手术麻醉方法中，明显优于芬太尼、异氟醚和司可林维持的平衡麻醉。

AIM： To compare the effects of total intravenous anesthesia and balanced anesthesia on stress response on suspensive laryngoscope vocal cords surgery. METHODS： Thirty patients undergone micmlaryngeal surgery were randomly divided into two groups（ n = 15）. Analgesia and amnesia slow induction was used in all patiens with nosal incubation. During maintenance of anesthesia, pmpofol, remifentanil and scopolamine were used in total intravenous anesthesia group（ group TIVA） ; fentanyl, scopolamine and isoflurane were used in balanced anesthesia group （group BAL）. Record the data of each group, including base data, after induction, end of tracheal intubation, 3 min after intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy, removing the trachea, MAP, HR of each time, the time of recovery. The blood concentrations of epinephrine （E）, noradrenalin （NE）, cortisol, IL-6 were measured at each time point of base data, end of tracheal intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy. RESULTS： There is no significant difference of HR, MAP, blood concentration of E, NE, cortisol, IL-6 at end of tracheal intubation compared with base data. AT setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy, HR, MAP, blood concentrations of E, NE, cortisol, IL-6 in group BAL were all higher than that of base data, and were also higher than group TIVA at the same time. The recovery time of group TIVA was shorter than that of group BAL. CONCLUSION： Analgesia and amnesia slow induction with nosal intubaion and maintenance with remifentanil, propofol can inhibit sudden change of hemodynamies and stress response of intubation and setring the suspensive laryngoscope, with quicker recovery .It is an ideal anesthesia method for suspensive laryngoscope vocal cords surgery.