舒芬太尼超前镇痛在甲状腺手术麻醉中的应用及对术后镇痛的影响

目的:探讨舒芬太尼超前镇痛在甲状腺手术的麻醉效果及对术后镇痛的影响。方法:选择择期甲状腺手术患者150例ASA(Ⅰ~Ⅱ)随机分成3组。Ⅰ组:舒芬太尼+局部浸润。Ⅱ组:芬太尼+局部浸润,Ⅲ组:单纯局部浸润。术后均连接Graseby9300镇痛泵(PCIA)病人自控静脉镇痛,镇痛药物均采用1%曲马多。分别记录生命体征HR、Bp的变化;术中Ramsay镇静评分法;术后各时点VAS评分;镇痛泵首次触发时间、有效触发次数及术后恶心、呕吐发生情况。结果:Ⅰ组:整个手术过程生命体征平稳,无明显呼吸抑制发生。Ⅱ组:整个手术过程生命体征基本平稳,但多数患者发生一过性呼吸抑制,需要面罩呼吸给氧。Ⅲ组:生命体征于手术中牵拉而不平稳,没有呼吸抑制发生。双盲观察麻醉满意程度评价Ⅰ组、Ⅱ组满意;视觉模拟评分(VAS)情况Ⅰ组各时间点均在3分以下,与其他组相比差别具有统计学意义(P<0.05)。Ⅰ组PCIA泵首次触发时间明显延长,按压次数减少,与其他组相比差别具有统计学意义(P<0.05)。结论:舒芬太尼超前镇痛在甲状腺手术中获得满意的麻醉效果,明显减轻术后疼痛,提高患者生活质量,减少不良反应发生,是甲状腺手术安全灵活有效的麻醉方法。

Pre-emptive analgesia effects of Sufentanil on perioperative anesthesia and postoperative pain management in patients undergoing thyroidectomy

Objective To study the pre-emptive analgesia effects of Sufentanil on perioperative anesthesia and postoperative pain management in patients undergoing thyroidectomy.Method 150 patients undergoing thyroidectomy were randomly assigned to three groups. Group I was administrated with Sufentanil intravenously and local anesthesia, group II was administrated with Fentanyl intravenously and local anesthesia and group III only received local anesthesia. All the patients received postoperative analgesia with patient controlled epidural analgesia(PCIA) and the drug was given 1% tramadol. The variety of heart rate and blood pressure were recorded after going into operation room and after operation. We chose double blind method to observe the satisfaction of anesthesia. VAS, the first trigger time of PCIA(min), the number of PCIA successful triggers and analgesic-related nausea and vomitting were observed.Results The vital signs all through the operation in group I were stable and without marked respiratory depression. The vital signs during the operation in group II were roughly stable, but majority of the patients had a reversible respiratory depression. The vital signs of group III were unstable because of perioperative drag and without respiratory depression. Evaluation of anaesthetic satisfaction using double blind method in group I and group II had a better outcome. VAS of each time point was under 3 points in group I and had significant difference with other groups( P<0.05 ). The first trigger times of PCIA in group I were markedly longer than other groups and had significant difference with them( P<0.05 ). There was no significant difference among groups considering postoperative nausea and vomiting.Conclusion Sufentanil has got a satisfactory anaesthetic effect when applied to pre-emptive analgesia in thyroidectomy. It can release postoperative pain apparently, raise patients' life quality and reduce adverse effect. It is a safe and effective anaesthetic drug in thyroidectomy.