两种麻醉方式在颈淋巴结结核手术中的麻醉效果对比研究

Comparative study of the effect of anesthesia in cervical lymph node tuberculosis operation between different anesthetic methods

目的：探讨不同麻醉方法在颈淋巴结结核手术中的应用。方法选取成都市公共卫生临床医疗中心2012年3月至2013年9月收治的100例颈淋巴结结核患者，随机分为两组（A、B组），A组分别静脉注射瑞芬太尼（0．5～1μg／kg）和异丙酚（0．3～0．4mg／kg）维持麻醉，B组分别静脉注射氯胺酮（1～2mg／kg）和异丙酚（0．3～0．4 mg／kg）维持麻醉，比较两组患者术中脉搏血氧饱和度（SpO2）、收缩压（SBP）、舒张压（DBP）、心率（HR），术毕苏醒情况及不良反应等指标。结果 A组患者SBP、DBP、HR和SpO2在诱导后、切皮时、搔刮病灶期间、手术结束时与入室时比较，差异无统计学意义（P＞0．05）；B组患者SBP、DBP、HR和SpO2在诱导后、切皮时、搔刮病灶期间、手术结束时与入室时比较，差异有统计学意义（P＜0．05）；与B组相比，A组患者苏醒时间明显缩短，不良反应发生率降低70％以上，术毕5 min Aldert评分明显高于B组（P＜0．05）。结论瑞芬太尼复合异丙酚和氯胺酮复合异丙酚均可用于颈淋巴结结核的手术麻醉，而前者麻醉效果及安全性均优于后者。

Objective To investigate the effect of different anesthetic methods in the cervical lymph node tu‐berculosis operation .Methods A total of 100 patients with cervical lymph node tuberculosis in the Public Health Clinical Center of Chengdu from Mar .2012 to Sep .2013 were enrolled in this study and randomly divided into two groups （group A and B） .Patients in group A were treated with intravenous injection of remifentanil （0 .5-1 μg/kg） and propofol （0 .3-0 .4 mg/kg） ,and patients in group B were treated with intravenous injection of ketamine （1-2 mg/kg） and propofol （0 .3-0 .4 mg/kg） .The systolic pressure （SBP） ,diastolic pressure （DBP） ,heart rate （HR） , oxygen saturation （SpO2 ） ,quality of postoperative recovery and untoward reactions were recorded and analyzed .Re‐sults In group A ,there were no statistical differences of SBP ,DBP ,HR and SpO2 levels on T2 ,T3 ,T4 and T5 com‐pared with that on T1（P＆gt;0 .05） .In group B ,there were significant differences of SBP ,DBP ,HR and SpO2 levels on T2 ,T3 ,T4 and T5 compared with that on T1（P〈0 .05） .Compared with group B ,the recovery time of group A was significantly decreased and the incidence of untoward reactions was decreased 70% （P〈0 .05） .And the 5 min after operation Aldert Score in group A was significantly higher than that in group B（P〈0 .05） .Conclusion Remifentanil combined with propofol and ketamine combined with propofol both could be used in cervical lymph node tuberculosis operation ,and the anesthetic effect of remifentanil combined with propofol could be better and safer than ketamine combined with propofol .