瑞芬太尼在支撑喉镜下声带息肉摘除术中的应用

目的探讨瑞芬太尼在支撑喉镜下声带息肉摘除术中的麻醉效果。方法选择美国麻醉学会分级Ⅰ-Ⅱ级的择期单侧声带息肉摘除术的患者60例，完全随机分为2组各30例。芬太尼组用芬太尼2峭／kg和异丙酚1～2mg／kg，琥珀胆碱1．5～2mg／kg诱导，术中仅异丙酚维持；瑞芬太尼组芬太尼改为瑞芬太尼诱导，瑞芬太尼、异丙酚维持。支撑喉镜置入前按需静脉注射琥珀胆碱20～30mg。观察2组诱导后、插管后、支撑喉镜置入时、术毕、拔管时血压、心率变化，术中异丙酚的用量、术后拔管时间并用警觉与镇静评分评价苏醒质量。结果芬太尼组血压、心率插管后分别为（146±6）mmHg、（100±3）次／min，喉镜置入时分别为（146±5）mmHg、（89±3）次／min，拔管时分别为（152±5）mmHg、（105±1）次／min]显著高于瑞芬太尼组，术中对异丙酚、琥珀胆碱的需求量及苏醒时间瑞芬太尼组均小于芬太尼组（均P〈0．05）；呼吸恢复时间、拔管时间无明显差异。改良警觉与镇静评分〉3分瑞芬太尼组4例，芬太尼组13例，差异有统计学意义（P〈0．01），且瑞芬太尼组无一例躁动，芬太尼组有6例躁动。结论瑞芬太尼可安全用于支撑喉镜下声带息肉摘除术，术中维持血液动力学稳定，术毕苏醒快，苏醒质量高。

Application of remifentainil in removing the vocal cord polyp under the suspension laryngoscope

Objective To investigate the effects of remifentanil anesthesia in removing the vocal cord polyp under the suspension laryngoscope. Methods Sixty ASA Ⅰ or Ⅱ patients scheduled for removing the one side vo-cal cord polyp were randomly divided into two groups(n = 30 each) :Group F: Anesthesia was induced with fentainil 2 μg/kg, propofol 1 ～2 mg/kg and Secoverine 1.5 mg/kg, and only propofol was maintained; Group R: Refentainil 2μg/kg, propofol and Secoverine were used for induction, and Refentainil and propofol maintained anesthesia. Sec-overine was administered before suspension laryngoscope placement. BP and HR were recorded after induction (T1) and tracheal intubation (T2) , suspension laryngoscope placement(T3), at the end of operation (T4) and extubation (T5). Also, the consumption of propofol and Secoverine in the operation, Extubation time and scores of OAA/S e-valuating the quality of awakening were recorded. Results BP and HR of patients at T1, T2, T3, T4 and T5 were significantly higher in group F than those in group R( P <0.01), the consumption of propofol and Secoverine in the operation were more in group F than thoses in group R(P <0.05). Extubation time was significantly earlier in group R than in the group F( P <0.05). The numbers of patients whose scores of OAA/S > 3 were more in group F than those in the group R(P<0. 01). Conclusions Remifentainil anesthesia can be safely used in removing the vocal cord polyp under the suspension laryngoscope, which can maintain hemodynamic stability and rapid recovery.