舒芬太尼复合丙泊酚静脉麻醉在鼻腔内窥镜手术的应用  

The application of total intravenous anesthesia of sulfentanyl combined with propofol in the nasopharyngoscope procedure

作　　者：万丽[1] 钱耀亮[1] 黄焕森[1] 高崇荣[1] 

机构地区：[1]广州医学院第二附属医院麻醉科,广东广州510260

出　　处：《国际医药卫生导报》2008年第17期68-71,共4页International Medicine and Health Guidance News

摘　　要：目的观察舒芬太尼复合丙泊酚静脉麻醉对鼻腔内窥镜手术患者血流动力学和苏醒期镇静评分的影响，探讨鼻腔内窥镜手术理想的麻醉方法。方法择期行鼻腔内窥镜手术成年患者30例，随机分为两组。Ⅰ组：舒芬太尼＋丙泊酚静脉麻醉组（n=15）；Ⅱ组：异氟醚＋丙泊酚静吸复合麻醉组（n=15）。两组麻醉诱导成功插管后，麻醉维持：Ⅰ组以舒芬太尼0．2ug·kg^-1·h^-1＋丙泊酚4～6mg·kg^-1·h^-1静脉持续泵注，Ⅱ组以1．3MAC异氟烷吸入＋丙泊酚4～6mg·kg^-1·h^-1静脉持续泵注，术中间断i．v追加芬太尼1～2ug／kg维持镇痛。以维库溴铵0．04mg／kg间断i．v维持肌肉松弛。分别记录两组患者麻醉前（T0），插管前（T1），插管后（T2），切皮后5min（T3），手术30min（T4），手术1h30min（T5），拔管时SBP、DBP、HR变化及苏醒镇静评分。结果两组患者麻醉诱导后插管前均出现SBP、DBP下降，与麻醉前相比，SBP下降差异具有极显著性，P〈0．01，DBP下降差异具有显著性，P〈0．05；气管插管时、切皮后5min、拔管时Ⅱ组SBP、DBP均明显增加，与Ⅰ组相比，差异具有显著性，P〈0．05。插管时、手术中及拔管时Ⅱ组HR明显快于Ⅰ组，两组相比差异具有显著性，P〈0．05。两组患者术毕自主呼吸均恢复，Ⅱ组患者苏醒期出现明显躁动，镇静评分为1分。而Ⅰ组则无明显躁动，镇静评分为2～3分。结论舒芬太尼复合丙泊酚全凭静脉麻醉用于鼻腔内窥镜手术对血压、心率的影响小于异氟烷复合丙泊酚麻醉，麻醉维持平稳，苏醒期无躁动，是目前鼻腔内窥镜手术较理想的麻醉方法。Objective In order to explore the ideal anesthetic methods in nasopharyngoscope procedure, we compared the effect of sulfentanyl combined with propofol intravenous anesthesia to isoflurane inspiration combined with propofol intravenous anesthesia on the hemodynamics and consencious recovery score. Methods Thirty adult patients undergoing nasopharyngoscope procedure were randomly divided into two groups： group Ⅰ （n = 15）-sulfentanyl combined with propofol intravenous anesthesia and group Ⅱ（n=15）-Isoflurane inspiration combined with propofol intravenous anesthesia. In the same way of intravenous induction, 0.2 ug ·kg^-1·h^-1 sulfentanyl and 2-4mg·kg^-1·h^-1 propofol were infused to the patients in group Ⅰ,and 1.5 MAC isoflurane were inspirated and 2-4mg·kg^-1·h^-1 propofol were infused to the patients in group Ⅱ.The muscle relaxation was maintained with 0.04mg/kg norcurium intermittent iv. Hemodynamic changes of SBP, DBP and HR were recorded by multiple function monitor, and the consencious recovery score was also recorded. Results The SBP and DBP of the patients were all reduced before intubation after induction in two groups, compared with pre-anesthesia, the difference was significant, P〈 0.05. The SBP, DBP and HR were all increased in group Ⅱ after intubation, section the skin on 5 and 30 min and extubation, compared with group Ⅰ,the difference was significant, P〈 0.05 The HR was more quick in group Ⅱ than group Ⅰ on 30 min and 1 hr 30min operation time, P〈0.05. After stop the drugs, the patients respiration were all recovered , and there are significant body active in group Ⅱ,but there are no in group Ⅰ.Conclusion Sulfentanyl combined with propofol intravenous anesthesia is an ideal anesthetic method in nasopharyngoscope procedure and the anesthetic is more stable.

关 键 词：舒芬太尼 丙泊酚 全凭静脉麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]