瑞芬太尼复合丙泊酚对声带息肉摘除术患者的麻醉效果及血流动力学的影响

Influence of Remifentanil combined with Propofol on anesthesia effect and hemodynamics of patients operated on excision of polyp of vocal cord

目的探讨瑞芬太尼复合丙泊酚对声带息肉摘除术患者的麻醉效果及血流动力学的影响。方法选择2011年1月~2013年1月在上虞市人民医院行支撑喉镜下声带息肉摘除术治疗患者62例,分为实验组和对照组,每组各31例。两组均予以气管插管全身麻醉,对照组采用丙泊酚和芬太尼复合麻醉,实验组采用丙泊酚和瑞芬太尼麻醉。观察麻醉诱导前（T1）、插入喉镜时（T2）、插入喉镜后5 min（T3）及拔除喉镜后1 min（T4）血流动力学变化,同时比较两组麻醉苏醒时间、拔管时间、拔管后镇静评分及不良反应。结果两组T1时HR、SBP、DBP、SpO2比较差异均无统计学意义（P〉0.05）,实验组T2、T3、T4时HR、SBP、DBP、SpO2与T1时比较差异均无统计学意义（P〉0.05）,对照组T2、T3、T4时HR、SBP、DBP、SpO2与T1时比较明显升高,差异有统计学意义（P〈0.05或P〈0.01）。与对照组比较,实验组T2、T3、T4时HR明显增快,SBP、DBP明显升高,SpO2明显降低,差异有统计学意义（P〈0.05或P〈0.01）;实验组麻醉苏醒时间、拔管时间、拔管后镇静评分、丙泊酚用量和不良反应发生率均少于对照组,差异有统计学意义（P〈0.05）。结论支撑喉镜下声带息肉摘除术采用瑞芬太尼复合丙泊酚麻醉能取得良好的麻醉效果,不良反应少,对患者血流动力学影响较小。

Objective To discuss the influence of Remifentanil combined with Propofol on anesthesia effect and hemodynamics of patients operated on excision of polyp of vocal cord. Methods 62 patients operated on excision of polyp of vocal cord from January 2011 to January 2012 were selected and divided into experiment group and control group with31 cases in each group. The patients in two groups were given general anesthesia by trachea cannula, and the patients in control group were given anesthesia of Propofol combined with Fentanyl while the patients in experimental group were given anesthesia of Propofol combined with Remifentanil. The hemodynamics changes before the anesthesia induction（T1）, at the time of Inserting the laryngoscope（T2）, 5 minutes after inserting the laryngoscope（T3） and 1 minute after pulling out the laryngoscope（T4） were observed, and meanwhile, the anesthesia recovery time, time of pulling out laryngoscope, sedation scores after pulling out the laryngoscope and untoward effect of patients in two groups were compared as well. Results The differences of HR, SBP, DBP and SpO2at T1period between the two groups were not statistically significant（P 0.05）; the differences of HR, SBP, DBP and SpO2in experiment group among T2, T3, T4period and T1period were not statistically significant（P 0.05）; the HR, SBP, DBP and SpO2in control group at T2, T3,T4period were all higher than those at T1period, the differences were statistically significant（P 0.05 or P 0.01）.The HR, SBP, DBP in experiment group at T3, T4period were higher than those in control group, the SpO2in experiment group at T3, T4period were lower than those in control group, the differences were statistically significant（P 0.05 or P 0.01）; the differences of anesthesia waking time, extubation time, sedation scores after extubation, dosage of Propofol, adverse effects rate in experiment group were all lower than those in control group, the differences were statistically significant（P 0.05）. Conclusion Remifentanil combined with Propofol has reliable anesthesia effect on patients operated on excision of polyp of vocal cord under the laryngoscope, has little untoward effect or influence on hemodynamics.