舒芬太尼在妇科宫腔镜手术中应用的研究

目的观察单纯应用舒芬太尼对宫腔镜手术患者呼吸及循环功能的影响,探讨在手术操作前一次性给药,使患者达到满意手术状态的可行性。方法选择拟行宫腔镜手术患者50例,随机均分舒芬太尼组(S组)和丙泊酚复合芬太尼组(PF组)。S组于手术操作前10 min,一次性静脉匀速泵注舒芬太尼0.25μg/kg,注药时间均持续5 min。PF组静注芬太尼1.0μg/kg、丙泊酚2.0 mg/kg,继而以5.0 mg/(kg·h)输注丙泊酚。观察术前基础值(T1),注药后5 min(T2)、10 min(T3)、15 min(T4)以及停药后5 min(T5)的循环、呼吸情况,并记录意识消失时间、清醒时间、定向力恢复时间。结果与T1相比,S组各时点MAP及HR无明显变化,1 min通气量(MV)减少(P<0.01),PETCO2升高(P<0.01),但均保持自主呼吸;而PF组T2～T4时,MAP明显下降,HR明显减慢(P<0.05),呼吸抑制明显,均需要进行控制呼吸或辅助呼吸,其中有20例患者出现呼吸停止。T5时,S组的MAP、HR与T1时相比差异无统计学意义,而PF组MAP明显降低(P<0.05),HR明显减慢(P<0.05)。T5时,两组的MV都减少(P<0.05),但S组明显高于PF组(P<0.05)。S组术中患者疼痛、皱眉、肢体运动,明显少于PF组(P<0.05),患者术中能够清醒而安静,而PF组患者均意识消失。结论在宫腔镜手术麻醉中,单纯输注舒芬太尼可使患者在保持自主呼吸的状态下安静且清醒的接受手术,对循环和呼吸影响比较轻微。

Clinical Research of Using Sufentanil in Gynecological Hysteroscopicopetation

Objective To observe the effect of applying sufentanil alone in hysteroscopic operation.Methods Fifty patients undergoing painless hysteroscopic operation,were randomly divided into two groups: sufentanil group(S) and propofolcombined fentanyl group(PF).Ten minutes before the operative procedure we pump sufentanil 0.25 μg/kg intravenous with an equal speed to S group,and the volume dose will be given in 5 minutes.Fentanyl was given in a bolus of 1.0 μg/kg and propofol was given in a bolus of 2.0 mg/kg slowly,followed by continuous infusion with 5.0 mg·kg-1·h-1 in group PF.The circumstance of circulation and respiration were recorded before the drug injection(T1),5 minutes after drug injection(T2),10 minutes after injection(T3),15 minutes after injection(T4),and 5 minutes after the injection stopped.The time of the consciousness vanish,waking time,orientation recovery time were also observed and recorded.Results Compared with T1 there were no significant differences in MAP or HR in group S,but the MV reduced(P<0.01),and the PETCO2 stepped up(P<0.01),the spontaneously breathing were all remaining;But in group PF,there were an obviously descend of MAP at T2～T4,and also the HR stepped down(P<0.05),the respiratory depression were obvious,all the patients need controlled respiration or assisted respiration.Among the total,there were 20 patients appeared respiratory arrest.The MAP,HR of group S at T5 to T1 showed no significant differences.But in groupPF,there were an obviously reduction of MAP and MV(P<0.05),and also the HR reduced(P<0.05).During the operation in group S,the pain,the frown and the body movements taking place in the operation were obviously less than PF group,and the patients were all remaining calm and awake,but in group PF their consciousness were all vanished.Conclusion The use of sufentanil alone in gynecological hysteroscopic operation could maintain the function of respiration and circulation at constant level and make adequate analgesia effect for gynecological hysteroscopic operation.