舒芬太尼联合氯诺昔康对七氟醚麻醉下鼻窦镜手术术后躁动的影响

目的 通过舒芬太尼联合氯诺昔康在七氟醚麻醉下鼻窦镜手术患者的应用,观察其对苏醒期躁动发生的影响。 方法 选择蚌埠医学院第一附属医院2015年11月-2016年10月择期七氟醚麻醉下行鼻窦镜手术患者60例,男性39例,女性21例,年龄20~60岁,ASA Ⅰ或Ⅱ级,采用双盲实验设计,按随机数字表法将患者分为3组:舒芬太尼组(S组)、舒芬太尼+氯诺昔康组(SL组)和对照组(C组),每组20例。3组麻醉方式均采用静吸复合全麻,术中七氟醚复合瑞芬太尼全程维持深度。分别于手术结束前30 min静注舒芬太尼0.2 μg/kg(S组)、舒芬太尼0.1 μg/kg+氯诺昔康8 mg(SL组)、等量0.9%氯化钠溶液(C组)。观察各组拔管时间、苏醒时间、拔管后躁动、VAS评分及术后24 h恶心和呕吐发生率。 结果 与C组比较,S、SL组拔管后躁动发生明显减少,VAS评分明显降低(均P<0.05),S组与SL组比较差异无统计学意义(均P>0.05)。与S组相比较,SL组和C组的拔管时间和苏醒时间短,术后24 h恶心和呕吐发生率低(均P<0.05),SL组与C组比较差异无统计学意义(均P>0.05)。 结论 静脉注射0.1 μg/kg舒芬太尼+氯诺昔康8 mg可以减少七氟醚麻醉下鼻窦镜手术患者术后躁动的发生,且不会增加患者术后苏醒时间、拔管时间以及术后24 h恶心呕吐的发生率。 

Effect of the combination of sufentanil and lornoxicam on preventing postoperative agitation in patients undergoing sevoflurane anaesthesia for endoscopic sinus surgery

Objective To observe the effect of the combination of sufentanil and lornoxicam on preventing postoperative agitation in patients undergoing sevoflurane anaesthesia for endoscopic sinus surgery. Methods Total 60 patients undergoing endoscopic sinus surgery during sevoflurane anesthesia were enrolled into this study. There were 39 men and 21 women, ranging from 20 years old to 60 years old. Both of them belonged to the ASA Ⅰ or Ⅱ. The double-blind experiment design was applied. According to the random number table, these patients were divided into three groups:the sufentanil group (S group), sufentanil+lornoxicam group (SL group) and the control group (C group), with 20 patients in each group. The inhalation anesthesia was used in all the three groups. During the operation, sevoflurane combined with the remifentanil was applied to maintain depth in the whole process. These patients were injected with sufentanil 0.2 μg/kg (S group), sufentanil 0.1 μg/kg+lornoxicam 8 mg (SL group) and equivalent 0.9% sodium chloride solution (C group) through the veins before finishing surgery for 30 min. The tube drawing time, recovery time, dysphoria after tube drawing, VAS scoring and post-operative 24 h nausea and vomiting occurrence of each group were observed. Results By comparing with the C group, postoperative agitation after tube drawing in S and SL groups was obviously reduced. VAS scoring was obviously reduced (P<0.05). There was no statistical significance between S group and SL group (P>0.05). The tube drawing time and recovery time of SL group and C group were reduced. The occurrence of nausea and vomiting during post-operative 24 h was reduced (P<0.05). There was no statistical significance between SL group and C group (P>0.05). Conclusion Intravenous injection of sufentanil and lornoxicam can reduce postoperative agitation in patients undergoing endoscopic sinus surgery during sevoflurane anesthesia. And it won't affect postoperative recovery, tube drawing time, and occurrence of nausea and vomiting during post-operative 24 h.