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[1]来伟,丁国友,帅君,等.表面麻醉下无肌松药气管插管在会厌声带手术麻醉中的应用[J].医学研究与战创伤救治(原医学研究生学报),2015,17(05):474-477.[doi:10.3969/j.issn.1672-271X.2015.05.008]
　LAI Wei,DING Guo-you,SHUAI Jun,et al.The application of surface anesthesia endotracheal intubation without muscle relaxant in the epiglottis vocal cords surgery anesthesia[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(05):474-477.[doi:10.3969/j.issn.1672-271X.2015.05.008]
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表面麻醉下无肌松药气管插管在会厌声带手术麻醉中的应用()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第17卷
期数:
2015年05期
页码:
474-477
栏目:
出版日期:
2015-09-30

文章信息/Info

Title:
The application of surface anesthesia endotracheal intubation without muscle relaxant in the epiglottis vocal cords surgery anesthesia
作者:
来伟; 丁国友; 帅君; 肖荣; 吴林纳; 江丽丽
330002 江西南昌，解放军94医院麻醉科
Author(s):
LAI Wei;  DING Guo-you;  SHUAI Jun;  XIAO Rong;  WU Ling-na;  JIANG Li-li.
Department of Anesthesiology， 94 Hospital of PLA， Nanchang， Jiangxi 330002， China
关键词:
表面麻醉; 无肌松药; 气管插管; 会厌声带手术
Keywords:
surface anesthesia;  without using muscle relaxant;  endotracheal intubation;  epiglottis vocal cords surgery
分类号:
R767.1
DOI:
10.3969/j.issn.1672-271X.2015.05.008
文献标志码:
A
摘要:
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。
Abstract:
Objective To evaluate the clinical application of surface anesthesia without muscle relaxant endotracheal intubation 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 relaxants (group Ⅰ)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 dosage ， 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 group Ⅱ compared 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 groupⅡ were more satisfied with anesthesia. Conclusion The surface anesthesia without using muscle 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.

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更新日期/Last Update: 2015-09-20