两种麻醉方法在声带息肉摘除术中的效果比较

目的比较瑞芬太尼静脉复合麻醉与芬太尼静吸复合麻醉在声带息肉摘除术中的临床效果。方法ASAI-II级择期行声带息肉摘除术患者60例，随机分为瑞芬太尼-丙泊酚组（I组）和芬太尼．异氟烷组（II组），每组30例。I组：瑞芬太尼诱导插管，瑞芬太尼一丙泊酚维持麻醉；II组：以芬太尼诱导插管后以异氟烷持续吸入维持麻醉。观察两组麻醉诱导及维持期间血流动力学变化和苏醒拔管时间及苏醒质量评分。结果I组麻醉术中循环波动较小，且显著低于II组。I组呼吸恢复、拔管、呼之睁眼及定向能力恢复时间均早于II组，且I组在拔管后5min的OAAS评分高于II组，组间差异有显著性。结论瑞芬太尼麻醉应用于声带息肉摘除术，不仅能有效地抑制气管插管和置人支撑喉镜时的应激反应，维持血流动力学稳定，而且具有苏醒迅速的优点。

Clinical effects of two anesthetic techniques in patients undergoing vocal polypectomy

Objective To compare the clinical effects of remifentanil intravenous combined anesthesia and fentanyl supplemented with Isoflurane inhalation in patients underwent vocal polypectomy. Methods Sixty ASA Ⅰ～Ⅱ patients with vocal polypectomy were selected and randomly divided into remifentanil-propofol group (group Ⅰ)and fentanyl-Isofiurane group(group Ⅱ ), each group was 30 patients. group Ⅰ were given anesthetic induction with fentanyl and maintenance with isoflurane; group Ⅱ were given anesthetic induction and maintenance with remifentanil and propofol. The anesthetic induction time, blood flow dynamics during maintenance phase,recovery time and quality were recorded. Results Anesthesia produce less circulatory fluctuation in group Ⅰ than that in group Ⅱ. Group Ⅰ was faster than group Ⅱ on recovery profile including the time of response to verbal commands, autonomous breathing, tracheal extubation and recovery of cognitive function. The OAAS score was higher in group Ⅰ than in group Ⅱ in 5 minutes after intubation. Conclusion Remifentanil intravenous anesthesia can achieve better recovery profile from anesthesia than fentanyl in vocal polypectomy. Remifentanil can inhibit the stress responses to tracheal intubation and laryngoscope inserted effectively with a stable circulatory function.