CAJ | 학술논문

目的：评价表面麻醉下无肌松药气管插管在会厌声带手术麻醉中的临床应用。方法全麻下择期行会厌、声带手术80例，随机分为2组：麻醉诱导中，肌松药气管插管组（Ⅰ组）予以静脉注射顺式阿曲库铵0．1 mg／kg后行气管插管；表面麻醉气管插管组（Ⅱ组）采用逐步口咽及气管内表面麻醉后行气管插管。记录2组麻醉诱导中气管插管前后各时间点的平均动脉压（ MAP）和心率（ HR）。评价两组气管插管评分分级情况，比较两组手术时间、术中丙泊酚和瑞芬太尼用量、手术结束至自主呼吸恢复和气管拔管时间，记录两组术后拔管期间的意识状态评分（ OAA／S），术后麻醉不良反应、术中知晓情况和患者麻醉满意度。结果两组共78名患者完成临床研究。两组MAP和HR变化相同，组间差异无统计学意义。两组气管插管条件相似，手术时间、全麻用药量比较差异无统计学意义（ P均＞0．05）。与Ⅰ组比较，无肌松药的Ⅱ组术后自主呼吸恢复迅速拔管更快，差异有统计学意义（ P＜0．05）。Ⅱ组术后气管拔管时和拔管后5 min OAA／S评分显著高于Ⅰ组，术后不良反应发生也明显少于Ⅰ组，整体麻醉满意度高。结论表面麻醉下无肌松药气管插管可以为会厌、声带手术麻醉提供良好的气道管理，缩短术后气管拔管时间，麻醉安全性更高。
목적：평개표면마취하무기송약기관삽관재회염성대수술마취중적림상응용。방법전마하택기행회염、성대수술80례，수궤분위2조：마취유도중，기송약기관삽관조（Ⅰ조）여이정맥주사순식아곡고안0．1 mg／kg후행기관삽관；표면마취기관삽관조（Ⅱ조）채용축보구인급기관내표면마취후행기관삽관。기록2조마취유도중기관삽관전후각시간점적평균동맥압（ MAP）화심솔（ HR）。평개량조기관삽관평분분급정황，비교량조수술시간、술중병박분화서분태니용량、수술결속지자주호흡회복화기관발관시간，기록량조술후발관기간적의식상태평분（ OAA／S），술후마취불량반응、술중지효정황화환자마취만의도。결과량조공78명환자완성림상연구。량조MAP화HR변화상동，조간차이무통계학의의。량조기관삽관조건상사，수술시간、전마용약량비교차이무통계학의의（ P균＞0．05）。여Ⅰ조비교，무기송약적Ⅱ조술후자주호흡회복신속발관경쾌，차이유통계학의의（ P＜0．05）。Ⅱ조술후기관발관시화발관후5 min OAA／S평분현저고우Ⅰ조，술후불량반응발생야명현소우Ⅰ조，정체마취만의도고。결론표면마취하무기송약기관삽관가이위회염、성대수술마취제공량호적기도관리，축단술후기관발관시간，마취안전성경고。
Objective To evaluate the clinical application of surface anesthesia without muscle relaxant endotracheal intuba-tion in epiglottis vocal cords surgery anesthesia.Methods Eighty patients undergoing elective epiglottis vocal cords surgery by general anesthesia, were randomly divided into two groups:In the anesthesia induction, the group of endotracheal intubation with muscle relax-ants (groupⅠ)was treated with intravenous cisatracurium 0.1 mg/kg before endotracheal intubation.The group of surface anesthesia endotracheal intubation ( groupⅡ) used stepwise oropharyngeal and endotracheal surface anesthesia before endotracheal intubation. The changes of the mean arterial pressure ( MAP) and heart rate ( HR) were recorded in each time point before and after endotracheal intubation.These intubating conditions of two groups were compared.The operation time, intraoperation propofol and remifentanil dos-age, the time of spontaneous breathing recovery and trached extubation after the end of the surgery were recorded and compared.The consciousness scores ( OAA/S) of postoperative extubation were recorded.Postoperative adverse reaction, intraoperative awareness and the patients’satisfaction about anesthesia of two groups was compared.Results Seventy-eight patients of two groups have completed the clinical study.The change of MAP and HR had no statistically significant difference during endotracheal intubation between two groups (P>0.05).The intubating conditions of two groups were similar.There was no statistically significant difference in the operation time and the total dosage between two groups ( P>0.05 ) .There was a rapid recovery of spontaneous breathing and a early extubation in groupⅡcompared with groupⅠ.The difference was significant ( P<0.05 ) .The OAA/S score of groupⅡ was significantly higher than groupⅠwhen extubating or 5 min after extubating.Compared with groupⅠ, the postoperative adverse reactions in groupⅡ were less significantly.The patients of groupⅡwere more satisfied with anesthesia.Conclusion The surface anesthesia without using mus-cle relaxant endotracheal intubation may provided a good management of the airway and a safety recovery of the postoperation in patients undergoing epiglottis vocal cords surgery anesthesia.