声门Yamamoto分级法与支撑喉镜下声带手术的心血管反应的相关性研究

摘要

目的 研究支撑喉镜下声带手术的心血管反应与声门Yamamoto分级法的相关性.方法 回顾本院自2000年1月-2009年12月以来,静脉全麻下在显微镜支撑喉镜下行声带息肉手术的成年患者,排除高血压和冠心病,ASA Ⅰ～Ⅱ级的201例患者,按直接喉镜下声门的Yamamoto分级法分为1、2、3、4级,相对应分为A、B、C、D组.记录不同分组的患者的手术时间、麻醉诱导前基础值(T1)、诱导后5min(T2)、气管插管后即刻(T3)、置人支撑喉镜后5 min(T4)、10 min(T5)、15 min(T6)、20 min(T7)、拔出支撑喉镜后5 min(T8)的平均动脉压和心率的变化.结果 声门显露为4级的D组3例患者因无法完成手术而不计入本研究.C组的手术时间比A、B组延长(P<0.05),A、B组的手术时间无差异.3组麻醉诱导后血压和心率明显下降(P<0.01).A组放置支撑喉镜后血压和心率变化无统计学意义,B组的T7比T1明显增加(P<0.05),C组的T4、T5、T6、T7比T1显著增加(P<0.01),且比A、B组的血压和心率显著增加(P<0.01),取出支撑喉镜后,3组的血压T8和T1无差异(P>0.05),而B、C组的心率T8比T1明显增快(P<0.05).结论 声门Yamamoto分级法与支撑喉镜下声带手术的心血管反应有较好的正相关性,3级患者要注意预防不良的心血管反应.%Objective To explore the association of glottic Yamamoto classification and cardiovascular response during suspension laryngoscopic surgery for vocal cord polyps. Methods The data on 201 ASA Ⅰ～Ⅱ adult patients who had no existing coronary heart disease and hypertension and had undergone suspension microlaryngoscopic surgery for vocal cord polyps between January 2000 and December 2009 in our hospital were analyzed. The patients were assigned to group A, B, C, or D based on corresponding grade 1,2, 3 or 4 on the glottic Yamamoto classification. The changes in MAP and HR were noted at different time points: before anesthesia induction (T1), 5min after anesthesia induction (T2),completion of tracheal intubation (T3), 5min (T4), 10min (T5), 15min, (T6), and 20min (T7)after laryngoscopic insertion, and 5min after laryngoscopic extraction (T8). Results 3 patients in group D excluded in this study because of failure of the surgery. The surgical duration was longer in group C than in groups A and B (P<0.05) but did not differ between group A and group B. MAP and HR were decreased obviously in groups A, B, and C (P<0.01). MAP and HR did not change significantly in group A after laryngoscopic insertion. T7 was markedly longer than T1 in group B (P<0.05). T4, T5,T6, and T7 obviously longer than T1 in group C (P< 0.01). MAP and HR were obviously greater in group C than in groups A and B (P<0.01). MAP did not differ between T8 and T1 in all the groups (P>0.05); while HR at T8 was obviously greater than that at T1 in groups B and C (P<0.05). Conclusions Glottic Yamamoto classification is positively related with cardiovascular response during suspension laryngoscopic surgery for vocal cord polyps. We should pay attention to the prevention of adverse cardiovascular response in grade 3 patients.