喉上神经阻滞对声带息肉摘除术患者血流动力学、苏醒期躁动及MDA的影响

Effects of superior laryngeal nerve block combined with remifentanil on the hemodynamics and restlessness as well as MDA in patients undergoing vocal cord polypectomy

目的探究并分析喉上神经阻滞对声带息肉摘除术患者血流动力学、苏醒期躁动及MDA的影响。方法选取2019年2月至2020年2月收治的91例需手术治疗的声带息肉的患者,按照随机数字表法将其分为观察组(n=45)和对照组(n=46)。2组患者均采用常规诱导方案(包括丙泊酚、芬太尼及小剂量顺阿曲库铵),术中使用瑞芬太尼、七氟烷维持麻醉深度。观察组在此基础上进行喉上神经阻滞。观察并记录2组患者临床资料(包括2组患者性别、年龄、体重、ASA分级、手术时间、术中出血及瑞芬太尼使用量)、手术前后血流动力学指标、苏醒恢复情况、苏醒期躁动评分、血清丙二醛(malondialdehyde,MDA)、总超氧化物歧化酶(T-SOD)浓度及不良反应。结果2组患者性别比、年龄、体重、ASA分级、手术时间、术中出血等一般资料比较差异无统计学意义(P>0.05),观察组患者瑞芬太尼使用量显著低于对照组(P<0.05);术前、术毕、拔管后30 min HR、MAP差异无统计学意义(P>0.05),2组患者治疗前后SpO2差异无统计学意义(P>0.05),观察组患者拔管时HR、MAP明显低于对照组(P<0.05);2组患者手术后躁动评分差异有统计学意义(P<0.05),2组患者拔管时躁动评分较苏醒时有所升高,拔管后30 min较苏醒及拔管时显著降低(P<0.05),但观察组患者躁动评分明显低于对照组(P<0.05);观察组患者自主呼吸恢复时间、睁眼时间以及拔管时间均明显低于对照组(P<0.05);重复测量资料方差分析显示,2组患者手术前后MDA、T-SOD浓度比较差异有统计学意义(P<0.05),术前2组患者MDA、T-SOD浓度比较差异无统计学意义(P>0.05),术后1 h 2组患者MDA水平显著升高(P<0.05),而T-SOD浓度显著降低(P<0.05),术后3 h 2组患者MDA水平较术后1 h显著降低,而T-SOD浓度较术后1 h显著升高(P<0.05)。观察组术后1 h、3 h MDA水平显著低于对照组(P<0.05),而术后1 h、3 h T-SOD浓度显著高于对照组患者,差异有统计学意义(P<0.05),2组患者均未出现严重不可逆不良反应。对照组患者术后恢复室出现恶心呕吐4例,低氧2例,给予面罩吸氧后缓解。观察组患者术后在恢复室出现恶心呕吐1例,声音嘶哑3例,术后6 h内恢复,术后低氧1例,面罩吸氧后恢复。其余未见不良反应。结论喉上神经阻滞联合瑞芬太尼能有效改善声带息肉摘除患者血流动力学,缩短声带息肉摘除患者的苏醒时间。同时,降低患者围术期应激反应,降低苏醒期躁动评分,值得临床推广。

Objective To investigate the effects of superior laryngeal nerve block combined with remifentanil on the hemodynamics and restlessness as well as MDA in patients undergoing vocal cord polypectomy.Methods A total of 91 patients with vocal cord polyp who were treated by vocal cord polypectomy in our hospital from February 2019 to February 2020 were enrolled in the study,who were randomly divided into observation group(n=45)and control group(n=46).The patients in both groups were treated by conventional induction program(including propofol,fentanyl and small dose of cisatracurium),and remifentanil and sevoflurane were used to maintain the depth of anesthesia.On that basis,the patients in observation group were treated by superior laryngeal nerve block.The clinical data(patient’s gender and age,body weight,ASA grade operation time,intraoperative bleeding and remifentanil dosage),hemodynamic indexes before and after operation,recovery of recovery,restlessness score during recovery,malondialdehyde(MDA),T-SOD concentration and adverse reactions were observed and compared between the two groups.Results There were no significant differences in patient’s sex and age,body weight,ASA grading operation time,intraoperative bleeding between the two groups(P>0.05).The use amount of remifentanil in the observation group was significantly lower than that in control group(P<0.05).There were no significant differences in HR and MAP before,after and at 30 minutes after extubation between the two groups(P>0.05).There were no significant differences in SpO2 levels before and after treatment in observation group(P>0.05),however,the HR and MAP at extubation in observation group were significantly lower than those in control group(P<0.05),and the restlessness scores in observation group were significantly lower than those in control group(P<0.05).The recovery time of spontaneous respiration,the opening time of eyes and the extubation time in observation group were significantly shorter than those in control group(P<0.05).Before operation there were no significant differences in the levels of MDA and T-SOD between the two groups(P>0.05),however,the MDA levels at 1 hour after operation in both groups were increased significantly(P<0.05),while the T-SOD levels were decreased significantly(P<0.05).The T-SOD levels at 3h,6h after operation in observation group were significantly higher than those in control group(P<0.05).In addition the severe adverse reactions were not found in both groups,but there were 4 cases of nausea and vomiting and 2 cases of hypoxia in control group.Conclusion The superior laryngeal nerve block combined with remifentanil can effectively improve the hemodynamics of patients undergoing vocal cord polypectomy,and shorten the recovery time of patients,moreover,which can reduce perioperative stress response and restlessness score at wake up period,thus,it is worthy of clinical promotion.