CAJ | 학술논문

目的：探讨在无肌松药全麻下行鼻内镜手术的可行性。方法将120例ASAⅠ～Ⅱ级择期行鼻内镜手术的患者随机分成常规肌松药组（Ⅰ组）及无肌松药插管维持组（Ⅱ组）各60例。Ⅰ组予维库溴铵0．08～0．1 mg／kg诱导，在患者有体动时，或每40 min静脉注射0．05 mg／kg维持肌松；Ⅱ组在复合气道充分表面麻醉后行气管插管，术中无肌松药维持。记录两组麻醉前（T0）、麻醉诱导后2 min（T1）、气管插管后2 min（T2）、手术开始后2 min（T3）、手术开始后20 min（T4）、拔管后5 min（ T5）各时点的血压（ MAP）、心率（ HR）、脉搏氧饱和度（ SpO2）、呼气末二氧化碳分压（ PetCO2），比较两组术中体动次数、麻醉苏醒及拔管时间、不良反应、并发症，以及术中追加输注瑞芬太尼、丙泊酚的用药量。结果两组T1时点MAP、HR较T0均有下降（P＜0．05），T2与T0比较差异无统计学意义（P＞0．05）；Ⅱ组T3时点MAP较T0上升，与Ⅰ组比较差异有统计学意义（P＜0．05）；Ⅰ、Ⅱ组术后命令反应时间[（9．0±2．4） min vs （2．1±1．2） min]、拔管时间[（15．1±3．6） min vs （3．5±1．6） min]、离室时间[（25．5±8．2） min vs （5．6±2．7） min]比较，Ⅰ组长于Ⅱ组，差异有统计学意义（P＜0．01）。结论无肌松药气管插管全麻下实施鼻内镜手术麻醉效果可靠，安全可行。
목적：탐토재무기송약전마하행비내경수술적가행성。방법장120례ASAⅠ～Ⅱ급택기행비내경수술적환자수궤분성상규기송약조（Ⅰ조）급무기송약삽관유지조（Ⅱ조）각60례。Ⅰ조여유고추안0．08～0．1 mg／kg유도，재환자유체동시，혹매40 min정맥주사0．05 mg／kg유지기송；Ⅱ조재복합기도충분표면마취후행기관삽관，술중무기송약유지。기록량조마취전（T0）、마취유도후2 min（T1）、기관삽관후2 min（T2）、수술개시후2 min（T3）、수술개시후20 min（T4）、발관후5 min（ T5）각시점적혈압（ MAP）、심솔（ HR）、맥박양포화도（ SpO2）、호기말이양화탄분압（ PetCO2），비교량조술중체동차수、마취소성급발관시간、불량반응、병발증，이급술중추가수주서분태니、병박분적용약량。결과량조T1시점MAP、HR교T0균유하강（P＜0．05），T2여T0비교차이무통계학의의（P＞0．05）；Ⅱ조T3시점MAP교T0상승，여Ⅰ조비교차이유통계학의의（P＜0．05）；Ⅰ、Ⅱ조술후명령반응시간[（9．0±2．4） min vs （2．1±1．2） min]、발관시간[（15．1±3．6） min vs （3．5±1．6） min]、리실시간[（25．5±8．2） min vs （5．6±2．7） min]비교，Ⅰ조장우Ⅱ조，차이유통계학의의（P＜0．01）。결론무기송약기관삽관전마하실시비내경수술마취효과가고，안전가행。
Objective To investigate the effect and feasibility of anesthesia without muscle relaxant in nasal endoscopic opera-tion.Methods 120 patients with ASAⅠ-Ⅱundergoing nasal endoscopic operation were randomly divided into normal muscle relaxant use group ( group Ⅰ) and intubation without muscle relaxant maintenance group ( groupⅡ) , 60 cases in each.GroupⅠwas treated with vecuronium 0.08-0.1 mg/kg induced, in patients with body movement or per 40min intravenous infusion of 0.05 mg/kg maintai-ning muscle relaxation;group Ⅱtracheal intubation after complex full airway surface anesthesia but without muscle relaxants mainte-nance during operation.Blood pressure ( MAP) , heart rate ( HR) , pulse oxygen saturation ( SpO2 ) , end tidal carbon dioxide partial pressure ( PetCO2 ) were recorded in each time point in the two groups before anesthesia ( T0 ) , 2 min after anesthesia induction ( T1 ) , 2 min after endotracheal intubation ( T2 ) , 2 min after the start of operation ( T3 ) , 20 min after the start of operation ( T4 ) , and 5 min after extubation ( T5) .The body movement frequency intraoperation , recovery time from anesthesia and extubation time, adverse reac-tions and complications and intraoperative additional infusion dosage of remifentanil and propofol were compared between the two groups.Results In both groups, T0 ~T4 each observation point,HR, MAP, SpO2 and PetCO2 changes were not significantly different (P>0.05).Breathing the air after 5 min(T5), SPO2 in group Ⅱwere higher than those in groupⅠ, PetCO2 in groupⅡlower than that in groupⅠ, there were significant differences between the two groups (P<0.05).In groupⅡ,anesthesia recovery time and ex-tubation time were significantly shorter than those in group Ⅰ( P <0.01).There were no adverse reaction and complication. Conclusions The effect of nasal endoscopic surgery under tracheal intubation general anesthesia without muscle relaxant is reliable, safe and feasible.