目的:观察鼻导管通气下丙泊酚复合瑞芬太尼靶控输注(TCI)行腮腺手术的麻醉效果.方法:选择60例择期行腮腺手术的患者,ASA Ⅰ～Ⅱ级,年龄18 ～ 65岁,体重50～90 kg.随机分成气管插管组(A,n=30)和鼻导管通气组(B,n=30),2 组均采用丙泊酚复合瑞芬太尼诱导,A组诱导后行气管内插管,B组诱导后置入鼻导管吸氧,术中调整丙泊酚的浓度以维持麻醉深度,并记录患者基础值(T0)、插管即刻(T1)、插管后1 min(T2)、3 min(T3)、5 min(T4)时的心率(HR)、血压(BP)、血氧饱和度( SpO2)、脑电双频指数(BIS).比较2组血流动力学、血气分析和麻醉后恢复的情况.结果:2组T1时BP、BIS均较T0值降低(P＜0.01)；与T1比较,2 组T2时BP均升高(P＜0.01),而在T3、T4时变化无差异(P＞0.05)；A组HR在T3、T4时低于T0(P＜0.05或P＜0.01)；组间比较,B组BP、HR在T2、T3时均低于A组(P＜0.01).2 组苏醒时间、拔管时间、术中动脉血气pH值和PCO2差异无统计学意义(P＞0.05).结论:鼻导管通气下行丙泊酚复合瑞芬太尼靶控输注在腮腺手术中能获得较满意的麻醉效果,血流动力学较气管插管组稳定.%Objective: To investigate the efficacy of nasal airway under target controlled infusion (TCI) of propofol and remifentanil in parotid surgery. Methods; 60 patients undergoing selected parotid surgery were divided into two groups(n =30). In group A, patients were intubated with endotracheal tube after anesthesia induction while in group B, nasal airway was applied. The anesthesia of two groups were both maintained with TCI of propofol and remifentanil. Patients' blood pressure( BP) , heart rate( HT) , pulse oxygen saturation (SpO2) and bispectral index (BIS) were recorded before intubation (To), immediately ( T,) and 1(T2), 3(T3), 5(T4)min after intubation. The blood gas values and recovery complications were also recorded. Results; BP and BIS were lower at T1 than at T0 and BP increased at T2 in both groups. In group A, HR decreased at T3 and T4 (P < 0.01). In group B, BP and HR were lower at T2 and T3 than those in group A(P<0.01). Conclusion: The nasal airway can be used in parotid surgery when anesthesia is maintained with TCI of propofol and remifentanil.
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