雷米芬太尼用于声带息肉切除术的临床观察

Anesthetic effect of remifentanil on the polypectomy of the vocal cord

目的观察雷米芬太尼用于声带息肉切除术的麻醉效果。方法声带息肉患者40例，ASA分级Ⅰ～Ⅱ级，随机分为2组，异氟醚A组20例（ISO组）；异丙酚-雷米芬太尼B组20例（PR组）。A组采用咪唑安定0．04rng／kg、芬太尼3μg／kg、维库溴铵0．1mg／kg、异丙酚1．5～2．0mg／kg；B组采用咪唑安定0．04mg／kg、维库溴铵0．1mg／kg、异丙酚1．5-2mg／kg、雷米芬太尼2μg／kg。A组在插管毕开始吸入异氟醚1．5～2．0MAC维持麻醉，必要时单次注射异丙酚1mg／kg；B组在插管毕则开始输注雷米芬太尼0．1～0．4μg／kg·min、异丙酚6～8mg／kg·h。监测血液动力学变化及苏醒、拔管时间，对所得数据进行统计学分析。结果两组相比，B组术中血液动力学较A组稳定，且苏醒迅速。结论雷米芬太尼静脉麻醉用于声带息肉切除术能达到平衡麻醉，可提供足够的麻醉深度。苏醒迅速完全。

Objective To observe the anesthetic effect of remifentanil on the surgery of vocal cord. Methods Forty patients, ASA Ⅰ～Ⅱ, were randomly divided into isoflurance group（Group A, n=20） and propofol-remifentanil group （Group B,n=20）. In addition to midazdan（0.04 mg/kg）, vecuronium（0.21 mg/kg）, and propofol（1.5-2 mg/kg） used in both groups,Group A added fentanylon （3μg/kg） and Group B added remifentanil （2 μg/kg）. In Group A, patients inbreathed isoflurance（1.5-2mac） to keep narcotism, and propofol（1 mg/kg） fractionated intravenous injection if necessary. In Group B,rernifentanil （0.1-0. 4μg/kg/min） and propofol （6-8 mg/kg/min） were injected intravenously after intubation. Hernodynarnic changes and the time of extubation and regaining consciousness were recorded for statistical analysis. Results Compared with Group A, the bernodynarnic changes in Group B was milder during surgery and the time to analepsla was quicker. Conclusion The application of rernifentanil during vocal cord polypectorny can reach the balance of anesthesia, providing enough depth of anesthesia and regaining consciousness rapidly and safely.