舒芬太尼复合咪达唑仑在乳腺癌手术麻醉苏醒中的应用

目的研究舒芬太尼+咪达唑仑在乳腺癌手术麻醉复苏中的应用,术后麻醉苏醒情况及拔管时血流动力学变化。方法选取ASAⅠ级,临床诊断为乳腺癌,拟行乳腺癌改良根治术患者60例,随机分为三组,每组20例,三组均采用气管内插管全身麻醉方式,以维库溴铵诱导插管,1组(F)以芬太尼+异丙酚+咪达唑仑维持麻醉,2组(S)以舒芬太尼+丙泊酚+咪达唑仑维持麻醉,3组(T)以舒芬太尼+丙泊酚+咪达唑仑维持麻醉,于术毕前10min停止丙泊酚输注,追加舒芬太尼+咪达唑仑,观察记录手术结束,取吸痰时,拔管时及拔管后MAP,HR,与基础值进行比较,记录呼患者睁眼时间,拔除气管导管时间和OAA/S评分。结果与术毕时比,F组和S组的MAP和HR在吸痰、拔管时均明显增高(P<0.05)。在睁眼时间、拔管时间两项观察指标中,各组之间差异有统计学意义,T组患者睁眼时间及拔管时间最短,S组次之,F组最慢,OAA/S评分T组评分较F组和S组明显升高(P<0.05)。结论舒芬太尼联合咪达唑仑用于乳腺癌手术患者,能保证很好的麻醉深度,术毕前10min追加舒芬太尼+咪达唑仑,拔管时心血管反应轻,术毕苏醒时间快,清醒状况良好,值得临床推广。

Application of Sufentanil combined Midazolam to the patients waking up after breast cancer operation

Objective To study the application of Sufentanil combined Midazolam in the surgical operation anaesthesia recovery in the breast cancer and analepsia condition after operation and the changes of hemodynamics.Methods The method selected 60 patients who was ASA Ⅰ class and the clinical diagnosis was a breast cancer,that had modified radical mastectomy.Patients were divided into three groups,each group patient had tracheal intubation anesthesia and induction and tracheal intubation and carried out by Vecuronium.Group 1（F）is maintained anesthesia by Fentanl,Propofol and Midazolam,group 2（S）was maintained anesthesia by Sufentanil,Propofol and Midazolam.Group 3（T） was maintained anesthesia by Sufentanil,Propofol and Midazolam and superaddition Sufentanil and Midazolam,stopping pumping propofol 10 minutes before the end of operation.Observed and recorded MAP,HR at the end of operation and the time of pull out tube while taking and sucking out phlegm and pulling out tube.Carried on a comparison with foundation value.Recorded the time that the patient opens eyes and pulls out windpipe pipe and OAA｜S grade point.Results Compared with the end of operation,MAP and HR of group F and group S obviously increase while sucking out phlegm and pulling out endotracheal tube（P0.05）.Each of the difference haD a statistics to learn difference by comparing two item observation index signs（the time of opening eyes and pulling out endotracheal tube）.Group T was the fastest group and group S was faster than group F.The OAA/S grade point of Group T was obviously increased compare with the OAA｜S grade point of Group F and Group S.（P0.05）.Conclusion Application of Sufentanil combined Midazolam to the patients after breast cancer operation can promise good anaesthesia depth.Superaddition Sufentanil and Midazolam 10 minutes before end of operation can reduce the changes of hemodynamics while pulling out tube.The method is worth clinical expansion for the recovery time is quickly and the condition of recovery is good.