无肌 松药全麻下实施鼻内镜手术的临床观察

目的探讨无肌松药（muscle loose medicine，NMB）全麻下鼻内镜手术的安全性和有效性。方法根据美国麻醉师协会（ASA）分级标准选择ASAⅠ～Ⅱ级择期行鼻内镜手术患者160例随机分为A、B两组，每组80例，均以瑞芬太尼、丙泊酚及氯化琥珀胆碱静脉快诱导，气管插管后A组以瑞芬太尼和丙泊酚维持麻醉，B组以瑞芬太尼、丙？白酚和维库溴铵维持麻醉。记录两组患者T1～T6各观察时点心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼末二氧化碳分压（EtCO2）、术中体动次数、麻醉苏醒时间、拔管时间、有无不良反应及并发症。结果两组患者T1～T4各观察时点HR、MAP、SpO2变化无明显差别（P〉0．05），术中无体动反应；T5、T6时点A组麻醉苏醒时间和拔管时间明显短于B组（P〈0．01），B组麻醉苏醒后，低氧血症、分泌物增多、心动过缓发生率明显高于A组（P〈0．01）。结论瑞芬太尼一丙泊酚无肌松药全麻下实施鼻内镜手术效果肯定，麻醉苏醒和呼吸功能以及保护性反射恢复早，避免了肌松药及其拈抗药的不良反应。

Effect of general anesthesia without muscle relaxants on endoscopic sinus surgery

Objective To study the safety and effectiveness of general anesthesia with no muscle relaxants for endoscopic sinus surgery. Methods 160 patients receiving endoscopic sinus surgery under general anesthesia were randomly divided into two groups equally. All patients were intubated after fast induction with intravenous administration of remifentanil, propofol, chlorinated succinylcholine. For maintenance of anesthesia, remifentanil and propofol were administrated intravenously in group A, remifentanil, propofol and vecuronium bromide in group B. Parameters of both groups were recorded, including heart rate （ HR ） , mean arterial blood pressure （ MAP ） , pulse oxygen saturation （ SpO2 ） , End tidal carbon dioxide partial pressure （ EtCO2 ） , intraoperative body moving times at T1 to T6 observation points, anesthesia recovery time and extubation time, adverse reactions and complications. Results During T1 to T4, the differences of HR, MAP, SpO2 between both groups were statistically insignificant （P 〉 0.05 ）, and without intraoperative body dynamic response. T5 and T6, the anesthesia recovery time and extubation time of group A were significantly shorter than those of group B （ P 〈 0. 01 ） . The ratios of hyoxemia, increased secretion, bradycardia occurred in group B were significantly more than those of group A. Conclusions With advantages of rapid recovery of respiratory function and protective reflection and avoidance of adverse reactions of muscle relaxants and their antagonists, general anesthesia with remifentanil-propofol but without muscle relaxants is affirmed for endoscopic sinus surgery.