全身麻醉复合1%丁卡因口底表面麻醉在显微支撑喉镜下声带息肉摘除术中的应用

The Application of General Anesthesia Combined with 1% Tetracaine Surface Anesthesia in the Treatment of Vocal Cord Polyp Removal under the Microscope

目的观察全身麻醉复合1%丁卡因口底表面麻醉在显微支撑喉镜下声带息肉摘除术中应用的效果,探讨其可行性和优越性。方法选择18~65岁间,ASAⅠ~Ⅱ级,无器质性心脏病和严重心律失常,择期行显微支撑喉镜下声带息肉摘除术患者60例,随机分为单纯全麻组(A组,n=30)和全表复合组(F组,n=30)。A组采用咪达唑仑-舒芬太尼-苯磺酸顺式阿曲库铵-丙泊酚诱导,瑞芬太尼-七氟醚维持麻醉方式,F组采用全麻诱导前1%丁卡因喷枪在口底部表面反复喷洒3~5次,待表麻起效后全麻诱导,方法同A组。观察记录两组静脉开放后(T0)、诱导后气管插管时(T1)、手术开始后下显微支撑喉镜时(T2)、术中摘除声带息肉时(T3)、术毕拔管时(T4)、Stew-ard评分≥5分离开PACU前(T5)等时间点的SBP、DBP、MAP、HR、SPO2,心律失常发生的病例数(N1),需使用心血管活性药物处理的病例数(N2),苏醒时间(H),拔管后急性气道并发症病例数(N3),咽部不适感和疼痛的分级(NRS)。结果与A组比较,F组血流动力学更稳定,安全系数更高,围术期意外及并发症发生率更低,苏醒时间(H)及术后咽部不适感和疼痛的分级(NRS),F组明显优于A组(P<0.05)。结论在显微支撑喉镜下声带息肉摘除术中应用全身麻醉复合1%丁卡因口底表面麻醉,循环稳定维持得更好,安全系数更高,苏醒时间更短,术后舒适度更佳。该麻醉方式更适合用于显微支撑喉镜下的声带息肉摘除术,值得进一步探讨和推广。

Objective To observe the effect of general anesthesia combined with 1% tetracaine surface anesthesia in the treatment of vocal cord polyp removal under the microscope, the superiority and feasibility of it are dis- cussed. Methods Choose between 18 to 65 years, ASA Ⅰ - Ⅱ level, without organic heart disease and severe ar- rhythmia, marked line 60 patients with microscopic under laryngoscope vocal polyp excision, were randomly di- vided into pure general anesthesia group （group A, n=30） and A full table of composite group （group F, n = 30）. Group A with midazolam-sufentanil-atracurium besylate - propofol induction, rui fentanyl - sevoflurane maintain anesthesia, group F use 1% tetracaine before induction of general anesthesia gun spraying on the surface at the bottom of the mouth repeatedly 3 - 5 times, after waiting for table linen effect during anesthesia induction and methods with A group. Observation record （TO）, the two groups after intravenous open endotracheal intuba- tion after induction （T1）, surgery after the start of next microscopic laryngoscope （T2）, intra-operative removal of vocal cords polyp （T3）, surgery （T4）, Steward BiBa tubes is grade 5 or more separate （T5） before PACU time points of SBP, DBP, MAP, HR, SPO2, cases（N1） of arrhythmia, to use drugs to deal with the number of cases of cardiovascular activity （N2）, awakening time （H）, cases （N3） of acute airway complications after extubation, pharyngeal discomfort and pain of classification （NRS）. Results Compared with group A, group F is more sta- ble hemodynamics, higher safety coefficient, but lower incidence of both peri-operative accident and complica- tions. Furthermore, waking time H pharyngeal and postoperative discomfort and pain grading （NRS）, group F is better than group A （1}〈0.05）. Conclusion The application of general anesthesia compound floor 1% tetracaine surface anesthesia under microscopic laryngoscope vocal polyp, is good for maintain circulation stabilization and higher safety coefficient, awakening time shorter, more good postoperative comfort, the anesthetic technique is more suitable for micro under laryngoscope vocal polyp excision, worthy of further discussion and promotion.