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。

Objective To investigate the effect and feasibility of anesthesia without muscle relaxant in nasal endoscopic operation. Methods 120 patients with ASA Ⅰ-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. Group Ⅰ was 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 maintaining muscle relaxation; group Ⅱtracheal intubation after complex full airway surface anesthesia but without muscle relaxants maintenance 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 reactions 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 Ⅱ were higher than those in group Ⅰ, PetCO₂ in groupⅡlower than that in group Ⅰ, there were significant differences between the two groups (P<0.05). In group Ⅱ,anesthesia recovery time and extubation 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.