支撑喉镜下喉显微手术麻醉中的特殊问题处理

Special treatment in anesthesia of laryngomicrosurgery under the suspension laryngoscopy

目的 :探讨不同麻醉方法对支撑喉镜声带手术的影响及特殊问题的处理。方法 :选 4 0例ASAⅠ -Ⅱ级择期支撑喉镜声带手术患者 ,随机分成两组 ,每组 2 0例。Ⅰ组麻醉诱导前采用 2 %利多卡因 2ml环甲膜穿刺或插管前雾化表面麻醉 ;Ⅱ组直接行全麻诱导。两组均用 2 %异丙酚 1～ 2mg/kg ,芬太尼 10 0 μg诱导后 ,给琥珀胆碱 1.5mg/kg ,顺利插入小型号Fr 6 .0钢丝气管导管后接omida麻醉机通气。术中用 2 %异丙酚泵注和异氟醚吸入维持麻醉 ,间断单次给予芬太尼。术毕给予地塞米松。记录两组诱导插管和拔管前后及放喉镜时HR、BP、SpO2 及PETO2 血气的变化 ,并记录手术时间和麻醉恢复时间。结果 :Ⅰ组的插管、拔管及放置喉镜引起的心血管反应较Ⅱ组明显轻 (P <0 .0 5 ) ;两组均无高碳酸血症及喉部并发症发生。结论 :表面麻醉复合全麻是支撑喉镜下行声带手术的更好麻醉方法 ,能有效减轻气管插管及放置喉镜引起的心血管反应 ,也为该手术提供较好的操作空间 ,又保证良好的通气和安全性。

Objective:To discuss the influence of different ways of anesthesia for surgery of vocal cord under laryngomicrosurgery.Methods:Forty ASA Ⅰ～Ⅱ patients undergoing surgery of vocal cord were randomly divided into two groups:Group Ⅰ ( n =20) received topical anesthesia of larynopharynx with 2% lidocaine 2ml before general anesthesia.Group Ⅱ ( n =20) received general anesthesia with topical anesthesia. Anesthesia was induced with 2% propofol 1～2mg/kg and fentanyl 100μg followed by vocuronium 0.1 mg/kg.The small-diameter Fr 6.0 trachea tube was intubated nasally.The lungs were mechanically ventilated.Anesthesia depth was maintained with 2.0 MAC isoflurance and propofol infusion 1～2mg/kg or discontinuous fentanyl.Dexamethasone was given at end of the procedure.ECG,HR,BP,S PO 2,P ET CO 2,blood gas were monitored during intubation,extubation or the microlaryngoscopy.Results:Cardiovascular reactions in Group Ⅰ were significantly less than in Group Ⅱ during intubation,extubation or placed microlaryngoscopy,and no complications occured in two groups.Conclution:Compared with topical anesthesia general anesthesia is a better method for surgery of vocal cord under laryngomicrosurgery.It can significantly relieve of cardiovascular effect and complication.