七氟烷与丙泊酚在支撑喉镜术麻醉中应用的比较

Comparison between Propofol and Sevoflurane during Operation with Suspension Laryngoscopy

目的比较七氟烷和丙泊酚分别复合瑞芬太尼靶控输注行静吸复合麻醉和全静脉麻醉用于支撑喉镜术的效果。方法ASAⅠ-Ⅱ级择期行支撑喉镜下声带息肉切除术患者40例,用随机数字表分为丙泊酚组(P组)和七氟烷组(S组),每组20例。麻醉诱导:静脉注射咪唑安定1.0～1.5mg,瑞芬太尼4μg/L血浆靶控输注,P组丙泊酚3mg/L血浆靶控输注,S组静脉注射丙泊酚1.5～2.0mg/kg,2组均用琥珀胆碱1.5～2.0mg/kg静脉注射后行气管插管控制呼吸。麻醉维持:S组吸入2%～4%七氟烷,使呼气末七氟烷浓度达到1MAC,同时靶控输注瑞芬太尼;P组仍为血浆靶控输注瑞芬太尼和丙泊酚。2组均静脉滴注琥珀胆碱,吸入65%氧化亚氮。随手术进程调整麻醉深度。记录患者不同时间点的平均动脉压(MAP)及心率(HR),记录苏醒时间、拔管时间及不良反应发生率。结果2组患者的HR在诱导后1min(T1)较术前(T0)明显降低(P<0.05)、MAP在诱导后1min(T1)及插管后1min(T2)较术前(T0)明显降低(P<0.05);P组患者在诱导后1min(T1)、插管后1min(T2)及术毕(T7)的HR明显低于S组(P<0.05);S组苏醒时间、拔管时间明显短于P组(P<0.05)。结论2种麻醉方法均可用于支撑喉镜术,应用七氟烷麻醉的患者诱导时血流动力学更加平稳、苏醒更快。

Objective To compare propofol with sevoflurane with remifentanil target-controlled infusion（TCI） respectively during operation of suspension laryngoscopy.Methods Forty ASA Ⅰ-Ⅱ patients scheduled for the vocal cord surgery through suspension laryngoscopy were randomly divided into two groups：Propofol group（P group） and Sevoflurane group（S group）,20 cases in each.Both groups were induced with intravenous midazolam 1.0～1.5 mg,succinylcholine 1.5～2.0 mg/kg and remifentanil 4 μg/L in TCI.P group was induced with Propofol 3 μg/ml in TCI and S group with intravenous propofol 1.5～2.0 mg/kg.After intubation,patients in S group inhaled 2%～4% sevoflurane to get sevoflurane concentration to 1 MAC,and combined with remifentanil in TCI.Patients in P group were maintained with remifentanil and propofol in TCI.HR and MAP at different time point,waking time,extubation time and side effects were recorded and compared.Results In both groups after induction,the HR at T1（1 min after induction） declined as compared with T0（before operation）（P〈0.05）,and MAP at T1 and T2（1 min after intubation） declined as compared with T0（P〈0.05）.But HR in P group at T1,T2 and T7（operation finished） declined more significantly than that in S group（P〈0.05）.While waking time and extubation time in S group were shorter than in P group（P〈0.05）.Conclusion Both methods of anaethesia can achieve good effect in the suspension laryngoscopy,but the patients maintained with sevoflurane had more stable hemodynamics and recovered sooner.