舒芬太尼用于鼻内窥镜局麻手术中强化麻醉的效果观察

目的评价舒芬太尼对鼻内窥镜局麻手术患者的镇静和镇痛效果。方法 60例ASAⅠ或Ⅱ级择期鼻内窥镜手术患者,年龄18～68岁,体重50～85kg,随机分为3组,每组20例。D组静脉注射派替啶(杜冷丁)1mg/kg,F组静脉注射芬太尼1μg/kg,S组静脉注射舒芬太尼0.2μg/kg。在局部麻醉的同时,将药物注入输液器中的茂菲氏滴管内,以每分钟60滴的速度输入。术中当VAS>5分时,用同样方法追加首次量的一半。各组均静脉复合咪达唑仑。于局部麻醉时(T1)、手术开始分离组织时(T2)以及手术结束时(T3)监测平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2),记录给药次数、手术时间、术中Ramsay评级、术中VAS评分,记录术后恶心、呕吐及嗜睡等不良反应的发生情况。结果在局麻时(T1)和手术中(T2),S组VAS显著低于其它两组(P<0.01),Ramsay达Ⅳ的例数显著多于D组和F组(P<0.05)。药物追加次数S组明显低于其它两组(P<0.05)。术后24h随访S组中对手术过程完全遗忘例数较D组和F组多(P<0.05)。术中MAP、HR、SpO2、手术时间以及术后不良反应的发生差异无统计学意义(P>0.05)。结论舒芬太尼完全可以安全有效的用于鼻内窥镜局麻术中的镇静和镇痛(强化麻醉),效果优于杜冷丁组和芬太尼组。

The observation on the effect of Sufetanil used for strengthening the anesthesia in the operation of nasal endoscopic local anesthesia

Objective The evaluation of the sedative and analgesic effect of Sufentanil applied to patients who need nasal endoscopic local anesthesia.Methods 60 patients who needed nasal endoscopic local anesthesia,aged from 18 to 68 years old of ASA level-1 or level-2,and their weight were from 50 to 85kg.These patients were randomly divided into 3 groups and every group had 20 patients.Dolantin was injected into the patients of group D according to 1mg/kg,while Fontanyl was injected into the patients of group F according to 1μg/kg.Sufentanil was injected into the patients of group S in line with 0.2μg/kg.During operating local anesthesia,making drug inject into Murphy’s drip pipe of infusion apparatus at the speed of 60 drops per minute.During the operation,when VAS was greater than the score of five,adopted the same method to add 1/2 drug of initial dose.Midazolam was injected into patients’ veins of every group.At the time of operating local anesthesia(T1),starting to separate the tissues(T2) and at the end of operation(T3),monitored the average MAP,HR and SpO2.And recorded the time administer drug,operating time,Ramsay rating,VAS score and the adverse reactions,such as nausea,vomit,drowsiness,etc.Results During the local anesthesia and the operation,VAS of Group S were obviously lower than that of other two groups(P<0.01).The patients’ Ramsay obtaining Ⅳwere significantly more than that of group D and group F(P<0.05).The frequency of adding drug to patients of group S was obviously lower than other two groups(P<0.05).24 hours after the operation,randomly visited patients from group S,and the number of patients from group S who totally forgot everything during the operation was more than that of group D and group F(P<0.05).The distinctions among every group on the MAP,HR,SpO2,the operating time and the adverse reactions after the operation were no statistical significances.Conclusion Sufentanil could be safely applied to the sedation and the analgesia in the surgery of nasal endoscopic local anesthesia,and the effect is superior to that of group D and group F.