三种全麻方法用于显微支撑喉镜下喉手术的临床观察

Clinical observation on three methods of general anesthesia to micro laryngoscopic operation

目的评价顺式阿曲库铵及琥珀胆碱三种不同给药方法在显微支撑喉镜下喉手术中的麻醉效果比较。方法择期显微支撑喉镜下喉手术患者60例，随机分成三组：顺式阿曲库铵组（A组，n=20）、顺式阿曲库铵加琥珀胆碱组（AH组，n=20）和琥珀胆碱组（H组，n=20）。静脉注射芬太尼2μg/kg，丙泊酚2mg／kg麻醉诱导，术中均微量泵注射丙？白酚6～10mg／（kg·h）。A组麻醉诱导时静脉注射顺式阿曲库铵0．15mg／kg。AH组麻醉诱导时先静脉注射顺式阿曲库铵0．075mg／kg，2min后再静脉注射琥珀胆碱1mg／kg。H组麻醉诱导时静脉注射琥珀胆碱2mg／kg。术中根据肌松监测适时追加肌松药。结果三组全麻方法都能满足手术要求。A组、AH组患者术中未再追加肌松药，H组所有患者均需追加肌松药（2．2±1．3）次，二次肌松药追加后，心率明显减慢（P〈0．05）。术中发生窦性心动过缓且需要注射阿托品的例数：A组有2例，AH组有3例，H组有20例。与H组比较，A组、AH组显著少于H组（P〈0．05）。三组丙泊酚用量无显著差异。术毕至拔除气管导管时间，AH组、H组显著短于A组（P〈0．05），AH组与H组比较无显著差异。术后24h随访，H组所有患者均发生全身肌肉酸痛，而A组、AH组患者均无全身酸痛症状发生（P〈0．05）。结论顺式阿曲库铵联合琥珀胆碱用于显微支撑喉镜下喉手术，肌松满意，心血管反应少，术后苏醒恢复时间短，术后并发症少，是一种安全、有效的方法。

Objective To evaluate three different administrations of Cisatracurium and Succinylcholine in the anesthesia during mi- cro-supported laryngoscopic laryngeal operation. Methods A total of 60 cases selective to undergo micro laryngoscopic operation were randomly divided into three groups. Cisatracurium group （ Group A, n = 20） , Cisatracurium and Succinylcholine group （Group AH, n = 20） and Succinyleholine group （Group H, n = 20）. Intravenous fentanyl （2 μg/kg） and Propofol （2 mg/kg an- esthesia） acted as inducers, and intraoperative Propofol 6 - 10 mg/（ kg . h） was administered via micro pump injection. During in- duction of anesthesia, Group A was treated with intravenous injection of Cisatracurium at 0.15 mg/kg, Group AH with intravenous injection of Cisatracurium at 0. 075 rng/kg and then Succinyleholine at 1 mg/kg 2-min later, and Group H with intravenous injection of Succinylcholine at 2 mg/kg. Additional muscle relaxants were added, if necessary. Results All the three anesthetic methods in the three groups met the requirements of operation. Group A and Group AH did not need additional muscular relaxants. All the pa- tients in Group H needed with a mean times of （2.2 ± 1.3 ） , and their heart rates slowed down significantly after the second addi- tional administration of the relaxants （ P 〈 0.05 ）. There were several cases of intraoperative bradycardia that needed treatment with atropine, i.e. 2 in Group A, 3 in Group AH 20 cases in Group H. Group A and Group AH were significantly less in the case num- ber of bradycardia than Group H （ P 〈 0.05 ）. There was no significant difference in the dosage of Propofol among the three groups. Time of extubation after operation was significantly earlier in both Group AH and Group H than in Group A （ P 〈 0.05 ） , and it was of no significant difference between Group AH and Group H. According to the follow-up 24 hours later after surgery, all the patients in Group H suffered from systemic muscle soreness, but those in Group A and Group AH did not encounter the disorder （ P 〈 0.05 ）. Conclusion The combination of Cisatracurium and Succinylcholine is safe and effective in micro laryngoscopic operation due to satisfactory muscular relaxation, less cardiovascular reaction and postoperative complication, and short postoperative recovery time.