瑞芬太尼复合丙泊酚对支撑喉镜下声带息肉摘除术患者血流动力学和应激反应的影响

Effects of Remifentanil Combined with Propofol on Hemodynamics and Stress Response during polypectomy of vocal cord by laryngoscope

目的比较芬太尼与瑞芬太尼分别复合丙泊酚用于支撑喉镜下声带息肉摘除术患者的血流动力学和应激激素变化。方法将100例行手术患者随机分为芬太尼复合丙泊酚组(F组)和瑞芬太尼复合丙泊酚组(R组),各50例,分别静脉注射芬太尼3.0μg/kg或瑞芬太尼1μg/kg和丙泊酚2.0 mg/kg、琥珀胆碱2.0 mg/kg实施麻醉诱导,记录两组诱导前(T0)、插支撑镜即刻(T1)、置支撑喉镜后1 min(T2)和拔管后1 min(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu)的变化和丙泊酚用量、麻醉恢复情况、药品不良反应。结果 F组T1,T2,T3时SBP,DBP,HR较T0时和R组对应时间点明显升高(P<0.05),NE,Cor,Glu水平均显著高于T0时和R组(P<0.05);术中丙泊酚追加量和总用药量F组显著高于R组(P<0.05),麻醉恢复时间F组明显长于R组。结论瑞芬太尼复合丙泊酚麻醉对血流动力学和应激反应影响小,是支撑喉镜下声带息肉摘除术中比较理想的麻醉药配伍组合。

Objective To compare the effects of fentanyl-propofol（F） or remifentanil-propofol（R） on stress responses and hemodynamics in polypectomy of vocal cord by laryngoscope.Methods One-hundred patients were randomly divided into group F and group R,50 cases in each group.The patients in group F were intravenously injected propofol 2.0 mg /kg,scoline 2.0 mg /kg combined with fentanyl 3.0 μg/kg and in group R were intravenously injected propofol 2.0 mg/kg,scoline 2.0 mg/kg combined with remifentanil 1 μg/kg as anesthesia induction.SBP,DBP,HR and the values of norepinephrine（NE）,cortisol（Cor）,blood glucose（Glu） were detected at different time points including before induction（T0）,immediately intubation（T1）,1 min after intubation（T2）,1 min after suspension laryngoscopy（T3）.Meanwhile,propofol dose,anesthesia recovery condition and drug＇s side effects were also recorded.Results In group F,the values of SBP,DBP and HR had significant increase at T1,T2 and T3 compared with T0 and group R（P 0.05）.In group F,the values of NE,Cor and Glu at T1-T3 were significantly higher than those at T0 and in group R（P 0.05）.The additional quantity and total dosage of propofol during operation in group F was obviously higher than those in group R（P 0.05）.The awaking time in group F was longer than that in group R without statistical significance.Conclusion Combined anesthesia of remifentanil and propofol could keep hemodynamic stable and minimum stress response,which might be an ideal drug combination in laryngeal microsurgery operation.