瑞芬太尼静脉麻醉在声带小结摘除术中的应用

The Application of Remifentanil Intravenous Anesthesia in Vocal Nodule Extirpation

目的研究不同剂量的瑞芬太尼静脉麻醉在声带小结手术中的应用。方法ASAⅠ～Ⅱ级择期行声带小结摘除术患者60例，随机分为3组，每组20例。芬太尼（F）组：芬太尼诱导插管后以异氟烷吸入维持麻醉；小剂量瑞芬太尼（L）组：瑞芬太尼诱导插管后以0．5μg／（kg·min）的速度持续输注维持麻醉；大剂量瑞芬太尼（H）组：瑞芬太尼诱导插管后以1μg／（kg·min）的速度持续输注维持麻醉。观察三组麻醉诱导及维持期血流动力学变化和苏醒期苏醒质量及相关时间。结果（1）H组麻醉术中循环波动较小，且显著低于F、L组。（2）L、H组呼吸恢复、拔管、呼之睁眼及离开手术室时间均早于F组，L、H组在拔管后5min的OAA／S评分高于F组。L、H组间差异无显著性。结论瑞芬太尼麻醉应用于声带小结摘除术，有术后苏醒快的优点。瑞芬太尼1μg／（kg·min）的速度持续输注能有效地抑制气管插管和置入支撑喉镜时的应激反应，维持血流动力学稳定。

Objective To study the application of doses of remifentail intravenous anesthesia in vocal nodule extirpation. Methods Sixty ASA Ⅰ-Ⅱ patients with vocal nodule were selected and randomly divided into three groups. Group F were given anesthetic induction with fentanil and maintenance with isoflurane; Group L were given anesthetic induction and maintenance with remifentail at the dose of 0.5 μg/（kg·min）; Group H were given anesthetic induction and maintenance with remifentail at the dose of 1 μg/（kg·min）. The anesthetic induction time, blood flow dynamics during maintenance phase, recovery time and quality were recorded. Results （1） Anesthesia produce less circulatory fluctuation in group H than in group F and L. （2） Group L and H were faster than group F on recovery profile including the time of response to verbal commands, autonomous breathing,tracheal extubation and discharging frmn operating room. The OAA/S score was higher in group L and H than in group F 5 min after intubation. There were no significant differences between group L and H. Conclusions Remifentanil intravenous anesthesia can achieve better recovery profile from anesthesia than fentanyl in vocal nodule extirpation. 1 μg/（kg·min） remifentanil can inhibit the stress responses to tracheal intubation and laryngoscope inserted effectively with a stable circulatory function.