无肌松药全身麻醉用于鼾症手术的临床研究

目的尝试在鼾症（OSAHS）手术全身麻醉维持中免用肌松药的可行性，探讨其临床价值。方法选择ASAI-Ⅱ级悬雍垂腭咽成形术（UPPP）鼾症患者180例，随机分为A、B、C三组（每组n=60），均以瑞芬太尼、丙泊酚及氯化琥珀胆碱静脉快诱导，经鼻明视或盲探气管插管，A组以瑞芬太尼、丙泊酚维持麻醉，B、C组分别在A组基础上加用阿曲库铵、维库溴铵维持麻醉。观察记录三组患者各时点循环和呼吸功能指标及术中肌松程度、体动次数、麻醉苏醒时间、拔管时间、不良反应及并发症等。结果三组气管插管成功率100％，麻醉维持平稳，无体动反应，均顺利完成手术；A组拔管前后清醒彻底，呼吸功能和肌力正常，无麻醉并发症发生，B、C组清醒后有不同程度肌松药残余，须使用新斯的明拮抗，拔管后分泌物增多、出血、心动过缓、低氧血症、舌后坠、喉痉挛、呼吸道梗阻、支气管痉挛发生率明显高于A组（P〈0．01）。结论瑞芬太尼一丙泊酚无肌松药全凭静脉麻醉维持用于鼾症手术安全有效，可明显缩短麻醉恢复时间，提高麻醉恢复质量，降低麻醉恢复期风险，减少并发症发生。

Clinical study of OSAHS surgery under general anesthesia without muscle relaxants

Objective To invertigate the feasibilityand clinical efficacy of OSAHS surgery under general anesthesia without muscle relaxants. Methods Totally 180 ASA I or 11 OSAHS cases underwent UPPP surgery were randomly divided into 3groups（ n = 60） , general anesthesia was induced with Remifentanil, Propofol and Succinylcholine, and maintained with Propofol and Remifentanil at group A. Group B, C added atraeurium, vecuronium to maintain anesthesia, on the basis of group A. Observed and recorded the three groups of patients at each time point circulatory and respiratory function parameters and the number of intraoperative muscle relaxants degree of body movement, anesthesia time, time to extubation, adverse reactions and complications. Results All patients of the three groups intubation success and remained stable anesthesia, no movement in response, were successfully operated; Gloup A completely sober before and after extubation , normal respiratory function and muscle strength, no anesthetic complications occur, Group B, C had varying degrees of muscle relaxants residual after sober, require the neostigmine . antagonize secretions increase after extubation, bleeding, bradycardia, hypoxemia, glossocoma, laryngospasm, airway obstruction, bronchial spasms were significantlyhigher than group A （P 〈 0. 01 ）. Conclusions Remifentanil - propofol without muscle relaxants intravenous anesthesia was maintained for OSAHS surgery is safe and effective, and can significantly shorten the anesthesia recovery time, improve the quality of anesthesia, reducing the risk of recovery from anesthesia to reduce complications.