瑞芬太尼在支撑喉镜下声带息肉摘除术中的应用

Administration of Remifentanil in vocal cord polyps extirpation

目的:研究瑞芬太尼替代肌松药在声带摘除术应用的可行性。方法:将60例ASAⅠ～Ⅱ级声带息肉患者,随机分为瑞芬太尼组(A组)和罗库溴铵组(B组),每组30例,记录诱导前、诱导后、插管即刻、术始、术毕时的HR、MAP变化,观察支撑喉镜置入后声带运动情况,记录手术时间、停药后呼吸恢复时间和拔管时间。结果:诱导后、插管即刻、术始、术毕时的A组HR、MAP显著比B组降低(P<0.05),与入室比较,A组MAP较B组稳定(P<0.05),A组HR明显降低(P<0.05),B组显著升高(P<0.05),与诱导前比较,诱导后两组HR、MAP均显著降低(P<0.05)。A组呼吸恢复时间和拔管时间明显短于B组(P<0.05)。结论:瑞芬太尼替代肌松药应用于声带摘除术安全可靠,术后呼吸恢复时间和拔管时间短,提高手术效率。

Objective： To study administration of Remifentanil without muscle relaxants in vocal cord polyps extirpation. Methods： Sixty ASA Ⅰ - Ⅱ patients with vocal cord polyps were randomly divided into two groups with 30 cases each group. The patients were injected intravenously Remifentanil 0.6 g/kg in group A and Rocurouium 0.6 mg/kg in group B during anaesthetic induction. The hemodynamics during anaesthetic induction, at intubation, cutting and operation completed were recorded. Time of resuscitation, extubation, operation and vocal cord polyps movement after laryngoscope inserted were observed. Results： The HR, MAP of group A were lower than those of group B at post-induction, intubation, cutting and operation completed （P〈0.05）. Compared with preoperatiou, the MAP of group A was more stable than that of group B（P〈0.05）, HR of group A decreased significantly, and that of group B increased significantly （P〈0.05）. The HR, MAP in two groups after induction decreased significantly compared with before induction. In group A, the resuscitation time was shorter and the quality of resuscitation was better than those in group B （P〈0.05）. Conclusion： Remifentanil without muscle relaxants under general anaesthesia can be used safely and effectively in vocal cord polyps extirpation with short resuscitation time and better quality of resuscitation.