摘要
目的:观察瑞芬太尼联合依托咪酯全麻喉罩通气用于甲状腺瘤手术对呼吸、血流动力学影响。方法:择期甲状腺手术患者90例,ASAⅠ～Ⅱ级,随机均分为A组、B组和C组,每组30例。A组采用颈丛神经阻滞复合依托咪酯;B组瑞芬太尼复合依托咪酯全麻气管插管控制呼吸;C组瑞芬太尼复合依托咪酯全麻喉罩自主呼吸通气。于麻醉手术前(T0),神经阻滞或全麻用药后即时(T1)、气管插管或喉罩置管后10min(T2)、切皮(T3)、术中分离甲状腺(T4)、手术结束(T5)、清醒睁眼(T6)、拔管(T7)时,分别观察并记录患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)的变化。同时观察并记录3组患者术中、术后不良反应及镇痛、镇静麻醉效果的满意度。结果:与麻醉前比较,A组SBP、DBP、HR明显升高(P<0.01);清醒、拔管时,B组与麻醉前比较,SBP、DBP、HR有不同程度显著升高(P<0.05);C组各时段SBP、DBP、HR、RR有不同程度微降,但差异无显著性(P>0.05)。清醒、拔管前,A组与B组或与C组比较,SBP、DBP、HR显著升高(P<0.01或P<0.05);清醒、拔管时,B组与A组或与C组比较,SBP、DBP、HR升高(P<0.05);3组患者RR、SpO2受到的影响较小,差异无显著性(P>0.05);术中、术后不良反应及镇静、镇痛麻醉效果满意度,A组与B、C组比较,效果及满意度差异有显著性(P<0.01)。结论:瑞芬太尼复合依托咪酯全麻喉罩通气用于甲状腺瘤手术,可控性好、安全有效、镇静、镇痛效果明显,能较好地抑制置管及手术刺激反应,对呼吸、血流动力学影响轻微。
OBJECTIVE To observe the effect of remifentanil and etomidate laryngeal mask airway under general anesthesia for thyroid tumor surgery on respiration and hemodynamics. METHODS The selected thyroid surgery 90 patients, ASA I-II, were randomly divided into three groups of 30 cases. A control group received cervical plexus block combined with etomid ate; The control B group received remifentanil and etomidate anesthesia endotracheal intubation controlled breathing; Study group C received remifentanil and etomidatc anesthesia laryngeal mask ventilation spontaneous breathing. Three groups of patients in the anesthesia before surgery （T0） ; Nerve block or general anesthesia immediately after treatment （T1） ; Nerve block, endotracheal intubation or laryngeal mask airway catheter after 10 minutes （T2） ; Skin incision （T3） ; Separation of thyroid sur gery （T4）; The end of surgery （T5）;A sober eyes open （T6）; extubation （T7）; The patient＇s systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, respiratory （RR）, oxygen satura tion （SpO2） changes were observed and recorded respectively adverse reactions and analgesia, sedation anesthesia satisfaction of intraoperative and postoperative were observed,too. RESULIS The three groups of patients, A group compared with the pre anesthesia, SBP, DBP, HR increased significantly （P〈0. 01 ）; B group awake, extubadon compared with the pre anesthesia, SBP, DBP, HR increased in varying degrees （P〈0. 05） ; SBP, DBP, HR, RR has slight decrease in varying degrees of C group at each time, no statistical significance （P〉0. 05）. Awake, extubation A group compared with B or C group, SBP, DBP, HR increased significantly （P〈0. 01 or P〈0. 05） ; Awake, extubation B group compared with A or C group, SBP, DBP, HR increased （P〈0.05） ; RR, SPO2 was less impacted in three groups of patients, no statistical significance （P〉0. 05） ; Compared with adverse effects and sedation an esthesia sati
出处
《中国医院药学杂志》
CAS
CSCD
北大核心
2010年第15期1282-1286,共5页
Chinese Journal of Hospital Pharmacy
关键词
瑞芬太尼
依托咪酯
喉罩
甲状腺瘤
呼吸
血流动力学
remifentanil
etomidate
laryngeal mask airway
thyroid tumor
respiration
hemodynamics
