瑞芬太尼在支撑喉镜声带手术中的临床应用

目的：比较瑞芬太尼或芬太尼复合异丙酚麻醉在支撑喉镜声带手术的临床效果。方法：选择．ASAⅠ～Ⅱ级择期行声带手术患者40例，随机分为两组：芬太尼组(F)和瑞芬太尼组(R)，每组20例。观察记录两组入手术室基础值(T0)、诱导后插管前(T1)、插管即刻(T2)、插管后5min(T3)、置入支撑喉镜前(T4)、置入支撑喉镜后(T5)、拨管时(T6)、拨管后5min(T7)各时点的心率(HR次/份)、SBP(mmHg)、DBP(mmHg)、苏醒时间及质量，记录患者拨管即刻、拨管后5min、15min、30min、1h的意识状态、认知功能、伤口疼痛程度等。结果：二组患者术后自主呼吸恢复时间、呼之争眼时间、拨管时间差异无显著性，F组置管反应发生率高于R组，术中循环波动较大，意识状态(OAAS)评分及疼痛评分(VAS)低于R组。结论：与芬太尼复合异丙酚麻醉相比，瑞芬太尼复合异丙酚麻醉在支撑喉镜下行声带手术中更平稳，清醒快且质量更高。由于瑞芬太尼半衰期短，患者术后很快就会感到疼痛，术后镇痛应及时。

Clinical application of Remifentanil to Suspensive Laryngoscopy Vocal Cords surgery

Objective:To compare the effect of different anesthetic as remifentanil and fentanyl propofol on Suspensive Laryngoscopy Vocal Cords surgery. Methods:Forty patients undergone microlaryngeal surgery were randomly divided into two groups (n=20 in each group). F is fentanyl propofol and R is remifentanil group. Record the data of each group, includes base data(T0), after conducting(T1), endotracheal intubation(T2), 5 min after intubation(T3), before setting the Suspensive Laryngoscopy(T4), after setting the Suspensive Laryngoscopy(T5), removing the trachea(T6), 5 min after removing the trachea(T7), HR of each time, SBP, DBP, the time of recovery and results. Record the effect of each group about their feelings, recognition, pains, and so on. Results:There is no significant difference between two groups about the recovery time. The reaction rate of F group is higher than R group, and also is fluctuant. The OAAS and VAS is lower than R group. Conclusions: Compared to fentanyl propofol, remifentanil used for the anesthetic of Suspensive Laryngoscopy Vocal Cords surgery is more stable, quicker recovery and effective. For the short half life of remifentanil, the patients will feel pain early, so the acesodyne should start in time.