全静脉麻醉用于支撑喉镜声带手术的临床观察
Clinical investigation of anesthesia with total venous anesthesia during suspension laryngoscope
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摘要: 目的: 评价全静脉麻醉方法在支撑喉镜声带手术中的应用。方法: 44例在全麻下行支撑喉镜声带手术成年患者,随机分为两组。两组均采用健忘镇痛慢诱导气管插管;麻醉维持A组采用瑞芬太尼-异丙酚,B组采用芬太尼-异氟醚。观察麻醉诱导、支撑喉镜置入、麻醉恢复各时点血流动力学的变化;记录停药到拔管到苏醒时间;比较停药10 m in后患者麻醉恢复质量。结果: ①血流动力学指标:两组患者在麻醉诱导后,血流动力学无明显变化,但在支撑喉镜置入后、拔气管导管时,两组血压、心率均呈升高趋势。其中A组数据无统计学意义;B组P<0.05;两个时间点血流动力学应激反应发生率,B组明显高于A组。②两组停药到拔管时间无明显差异;B组停药到苏醒时间短于A组,P<0.05。③B组麻醉恢复评分明显高于A组。结论: 选择芬太尼、瑞芬太尼联合异丙酚的全静脉麻醉用于该类手术,较芬太尼-异氟醚静吸复合麻醉,具有血流动力学更加稳定,苏醒快,恢复质量高的优点。Abstract: Objective: To evaluate the clinical profile of total venous anesthesia using fentanyl-propofol-reminfentanil. Methods: 44 ASA Ⅰ-Ⅱadult patients undergoing elective laryngo-microsurgery under the suspension laryngoscopy were randomly divided into two groups.All patients were induced with fentanyl-propofol followed by topical anesthesia of larynopharynx with 2% dicaine.Group A(n=22) received general anesthesia with remifentenyl-propofol infusion.Group B(n=22) received general anesthesia with fentanyl-isoflurane during mantenance.The time from administration of anesthetics stopped until eye opening and tracheal extubation,and Modified Aldrete recovery score 10 minute after administration of anesthetics stopped were recorded.( Results: (1))Haemodynamic index didn’t vary significantly in both group after induction.during placed.The incidence of Cardiovascular stress reactions to placed microlaryngoscope or extubation in group B were significantly higher than that in group A.((2)Time) from administration of anesthetics stopped to tracheal extubation wasn’t different in A and B group.Recovery time of emergence was shorter in group A than in group B.Recovery quality was much more better in group A than in group B.( Conclusion: Compared) with general anesthesia using fentanyl-isoflurane.Total venous Anesthesia with fentanyl,remifentenyl and propofol was a better method for suspension laryngoscope than general anesthesia with fentanyl-isoflurane.It can achieved the optimal hemodynamic stability during anesthesia induction and maintenance,and better recovery profile from anesthesia.
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