丙泊酚复合米库氯铵用于声带息肉摘除麻醉的临床观察

Clinical observation on propofol combined with mivacurium in the polyp of cord resection anesthesia

目的观察丙泊酚复合米库氯铵用于声带息肉摘除麻醉的临床效果和安全性。方法选择择期全麻下行声带息肉摘除术患者80例,随机分为治疗组(40例)和对照组(40例)。对照组用丙泊酚2.0 mg/kg、罗库溴铵1 mg/kg、咪唑安定0.1 mg/kg、芬太尼3μg/kg诱导后插管,治疗组用米库氯铵0.2 mg/kg代替罗库溴铵,其他同对照组诱导后插管,计算两组患者插管时间、手术时间、呼吸恢复时间、呼叫睁眼时间、拔管时间和插管前、插管后、术中、拔管前、拔管后血压、心率、血氧饱和度的变化情况,同时记录术后发生恶心、呕吐、躁动及围拔管期不良记忆等不良反应的发生率。结果治疗组插管时间长于对照组,两组比较差异有统计学意义(P<0.05);治疗组呼吸恢复时间、呼叫睁眼时间、拔管时间均明显短于对照组,两组比较差异有统计学意义(P<0.01)。治疗组患者拔管前的平均血压和心率明显低于对照组,两组比较差异有统计学意义(P<0.01)。治疗组患者有3例发生躁动,2例发生不良记忆,均明显低于对照组,两组比较差异有统计学意义(P<0.05);两组患者恶心、呕吐的发生率差异无统计学意义。结论丙泊酚复合米库氯铵用于声带息肉摘除麻醉可以缩短术后拔管时间、减少拔管前血流动力学波动及术后不良反应发生,二者复合应用安全有效,值得临床推广。

Objective To observe the clinical effect and safety of propofol combined with mivacufiurn in the polyp of vocal cord resection anesthesia. Methods Patients scheduled for polyp of vocal cord resection under general anesthesia （80 cases） were randomly divided into the treatment （40 cases） and control （40 cases） groups. In the control group, the patients were induced with pmpofol 2.0 mg/kg, rocuronium 1 mg/kg, imidazole valium 0.1 mg/kg, and fentanyl 3 ~tg/kg; While the patients in the treatment group were induced with mivacurium 0.2 mg/kg instead of rocttronium, and the others were the same as the control group. The time of intubation, operation, respiration, open eyes and extubation were recorded. The MAP, HR and SPO2 of before intubation, after intubation, the period of operation, before extubation and after extubation were recorded. The adverse reactions of nausea, vomit, restless, and bad memory during the periopemtion were observed. Results The intubation time of treatment group was more than control group with significant difference （P 〈 0.05）. The time of extubation, respiration and open eyes, adverse reactions, fluctuation of MAP and HR before extubation of treatment group were less than control group with significant difference （P 〈 0.01）. There were three cases restless and two cases bad memory in the treatment group, and the incidences of restless and bad memory were less than control group （P 〈 0.05）. The patients with nausea and vomiting in the two groups had no statistically differences. Conclusion Propofol combined with mivacurium applies in polyp of vocal cord resection anesthesia not only safely, but also can reduce the time of intubation and the adverse reaction, decrease the fluctuation of MAP and HR before extubation, which is worthy to promote the application in clinic.