舒芬太尼或芬太尼复合咪唑安定在慢诱导麻醉中对呼吸功能的影响  

Effects of sulfentanyl or fentanyl combined with midazolam on respiratory function during slow induction of anesthesia

作　　者：张艺泷[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉科,北京100853

出　　处：《解放军医学杂志》2007年第2期150-152,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的比较舒芬太尼与芬太尼复合咪唑安定用于健忘镇痛慢诱导气管插管时对呼吸功能的影响。方法40例择期手术患者,ASAⅠ～Ⅱ级,随机分为芬太尼组和舒芬太尼组,各20例。两组病人均静脉滴注咪唑安定0.03mg/kg,随后芬太尼组静脉注射芬太尼2μg/kg,舒芬太尼组静注舒芬太尼0.2μg/kg。注射镇痛药5min后,环甲膜穿刺注入1%丁卡因注射液2ml行喉和气管黏膜表面麻醉,3min后直视下气管插管。记录静脉注药前、注药后1、2、3、4、5min、环甲膜穿刺及插入气管导管前、后各时间点呼吸指标(呼吸频率、潮气量、每分通气量、呼气末二氧化碳分压及脉搏血氧饱和度)、循环指标(平均动脉血压、心率)和镇静深度。结果两组注药2min后均出现以呼吸频率减慢为主的呼吸抑制,芬太尼组呼吸频率下降较舒芬太尼组显著,20例中有10例因呼吸指标达到“呼吸介入标准”而进行指令呼吸或辅助呼吸,舒芬太尼组仅有2例达到“呼吸介入标准”。结论与咪唑安定复合麻醉时,等效镇痛剂量的舒芬太尼镇静作用强于芬太尼,而呼吸抑制作用低于芬太尼,故舒芬太尼更适合应用于保留呼吸的慢诱导气管内插管。Objective To compare the influences of sulfentanyl or fentanyl combined with rnidazolam on respiratory function in slow induction of anesthesia. Methods Forty ASAⅠ-Ⅱ patients were divided into two groups. Anesthesia was induced with rnidazolarn 0. 03mg/kg in both groups, and fentanyl 2μg/kg （i. v. ） was given in fentanyl group or stdfentanyl 0. 2μg/kg （i. v. ） in sulfentanyl group, Five minutes later, 2ml of 1 % decicaine was administered by cricothyroid membrane puncture to facilitate the intubation. Respiratory indexes （respiratory frequency, VT, MVV, PETCO2, SPO2 ）, circulatory indexes （MAP, HR） and sedation level were measured before and 1, 2, 3, 4, 5 minute（s） after injection of drugs, at cricothyroid membrane puncture, and pre- and post-intubation. Results Patients showed respiratory depression （respiratory frequency was reduced） in both groups 2 minutes after injection of drugs. However, respiratory frequency was decreased more markedly in fentanyl group than that in sulfentanyl group. Ten out of 20 patients were obliged to receive breathing intervention in fentanyl group, but two in sulfentanyl group. Conclusion In combination with midazolarn, sedative effect of sulfentanyl is stronger than that of fentanyl in equivalent analgesic dose, but with less respiratory depression. Sulfentanyl may be more suitable for slow induction of anesthesia.

关 键 词：舒芬太尼 芬太尼 慢诱导气管插管 清醒镇静 呼吸功能不全 

分 类 号：R614[医药卫生—麻醉学]