不同麻醉方法对支撑喉镜喉显微手术效果的影响

The Effect of Different Anesthetic Methods on Microlaryngoscopic Surgery under the Suspensive Laryngoscopy

目的 :比较气管内插管、高频喷射给氧、静脉复合麻醉与强化表面麻醉、双侧喉上神经及舌下神经阻滞在支撑喉镜显微手术中的效果和可行性。方法 :择期行支撑喉镜声带手术 52例病人 ,随机分二组 ,每组 2 6例 ,组Ⅰ用芬太尼 2 .0 μg/kg、氟哌啶 5mg、异丙酚 2 .0～ 2 .5mg/kg及氯化琥珀胆碱 1 .5～ 2 .0mg/kg诱导后 ,经口插入F2 6 气管导管 ,按喷射呼吸机常频控制呼吸 ,泵入 2 %普鲁卡因 0 .8mg～1mg/kg/min维持麻醉。组Ⅱ ,咽喉喷 1 %的卡因三次 ,环甲膜声门下腔注入的卡因作表面麻醉。双侧喉上神经及舌下神经分别注入 1 %布匹卡因 (每处 0 .75mg)行阻滞麻醉。术前 2 0分钟肌注度冷丁 80mg～1 0 0mg/人次。 结果 :两组术中收缩压、舒张压及心率较术前明显提高 (P <0 .0 1 ) ,但基本稳定 ,血动力学改变对手术效果无影响 ,术后组Ⅱ恢复术前水平明显快于组Ⅰ。两组间血动力学变化无显著性差异 (P>0 .0 5) ,两组血氧饱和度术前、术中及术后无显著性差异 (P >0 .0 5)。近期疗效观察 :组Ⅰ住院时间长(P <0 .0 1 ) ,并发症多 (P <0 .0 1 )。住院近期治愈率较低 (P <0 .0 5) ,总有效率与组Ⅱ无明显差异 (P >0 .0 5)。结论 :施行支撑喉镜喉显微手术时局麻法与全麻法均有较可靠安全性 ,但局麻可行性优于全麻 。

Objective To compare the effect of different anesthetic methods on microlaryngoscopic surgery to provide basis of the clinical application of local anesthesia.Methods Fifty two patients undergone microlaryngeal surgery were randomly divided into two groups (n=26 in each group).In group I,the introductive anesthesia was firstly conducted by giving fentanyl 2.0 μg/kg,droperidol 5mg/kg,proprofol 2.0～2.5mg/kg and succinylcholine 1.5～2.0mg/kg.Secondly,respiration was controlled by jet ventilator with ordinary frequency after endotracheal intubation and then 2% procaine was pumped into vein to sustain anesthesia.In group Ⅱ,following spraying 1% dicaine to pharyngolaryngeal membrane,1% dicaine was injected into infraglottis cavity through intercricothyroid membrane as the surface anesthesia.Bilateral supralaryngeal and sublingual nerves were both blocked by injection of 1% bupivacaine.Results Systolic pressure,diastolic pressure and HR of patients in two groups during surgery were obviously higher than those before surgery (P&lt;0.01).After surgery,the time for recovery of above indices in group Ⅱ was shorter than that in group Ⅰ.Between two groups,there was no significant difference about the hemodynamic changes (P&gt;0.05) and SpO 2(P&gt;0.05) before,during and after surgery.Recent effectivity showed that there was longer time in hospital and more complications in group Ⅰ(P&lt;0.01).There was no difference of total effective rates between two groups.Conclusion Both local and general anesthesia are safely adopted for performing suspensive laryngoscopy micro surgery,but the possibility of local anesthesia is better than that of general one.Two methods shall be choosed according to various condition.and it cannot be substitued each other.