静脉注射芬太尼用于硬膜外麻醉初期的可行性

目的]评价创伤急症手术时静脉注射芬太尼用于硬膜外麻醉初期以争取手术时间的可行性。方法]取L3．4间隙行硬膜外穿刺并置管，常规硬膜外给药，待出现温度感觉平面后，芬太尼组静脉注射芬太尼2mg/kg，哌替啶组静脉注射哌替啶1．5mg/kg，观察各组病人在麻醉前、出现温度感觉平面时、用药后2min时、用药后7min时心率、血压、脉搏氧饱和度及呼吸频率的变化，同时观察术中不良反应并评价各辅助药的争取手术时间的可行性。结果]用药后2min(即搬动患肢清洗及消毒)与出现温度感觉平面时比较，芬太尼组病人的血压轻度下降且波动较小，而哌替啶组及对照组病人则明显升高，且对照组波动幅度比哌替啶组大。用药后7min与用药后2min时相比，芬太尼组病人的各项指标无明显变化，哌替啶组及对照组的心率及血压有一定的下降术中各组患镇痛效果均满意。结论]芬太尼应用于急症手术硬膜外麻醉初期可以争取手术时间，是方便、安全及有效的。

The possibility of intravenous injection of fentanyl during epidural anesthetic initiation

OBJECTIVETo evaluate the possibility of using fentanyl during the initial period of epidural anesthetic to reduce the time before operation in acute patients.METHODSEpidural anesthesia puncture was applied at the L 3-4 interspace and the anesthesia was maintained with Lidocaine combined with Bupivacine.When the temperature plane occurred, group F were injected with 2mg/kg fentanyl, and group P with 1 5mg/kg pethidine. The change of blood press, heart rate, SpO 2 and breath frequency were observed after the temperature plane occurred two minutes and seven minutes later. At the same time, bad reactions were observed and the possibility of each drug shorten the time before operation was evaluated.RESULTSTwo minutes after injection, blood press was decreased a little in group F while that increased outstandingly in group P and C. The variation extent in group C was greater than that in group C. Seven minutes after injection in comparison with two minutes after injection, all items in group F had no outstanding changes, while the patients blood press and heart rate in group P and C had a certain decrease. All the patients in the three groups felt no pains during the operation time. Bad reaction in group F and C was much less than that in group P. Satisfied conditions in group F was better than that in group P, group P was better than group C, too. And meanwhile, differences were obvious between each group.CONCLUSION It is safe and helpful to inject fentanyl intravenously during the initial period of epidural anesthesia to reduce the time before operation in acute patients.