经鼻和/或静脉给予舒芬太尼用于宫腔镜手术病人的清醒镇痛  

Intranasal and Intravenous Sufentanil for Analgesia in Awake Patients Undergoing Hysteroscopy

作　　者：董弘[1] 王继爱[1] 王荣[1] 任宪凤[1] 林长赋[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,哈尔滨150086

出　　处：《中国医药导刊》2012年第9期1529-1530,共2页Chinese Journal of Medicinal Guide

基　　金：黑龙江省教育厅科学技术研究项目(项目编号11551229)

摘　　要：目的：比较经鼻和/或静脉给予舒芬太尼用于宫腔镜手术病人清醒镇痛的效果。方法：择期拟行宫腔镜手术的病人60例,ASA I或II级,年龄（28~48）岁,随机分为3组（n=20）：Ⅰ组缓慢静脉注射舒芬太尼0.3μg/kg,II组缓慢静脉注射舒芬太尼0.1μg/kg,同时鼻腔滴入舒芬太尼0.26μg/kg,Ⅲ组鼻腔滴入舒芬太尼0.39μg/kg（舒芬太尼鼻腔给药生物利用度可达78%）。术中根据情况酌情追加丙泊酚（0.5～1.0）mg/kg。记录静脉注射咪达唑仑0.03 mg/kg,2min后（T0）、给予舒芬太尼后（2、4、6、8）min（T1-4）及手术开始时（T5）的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、呼吸次数（RR）的数值;并分别记录镇痛评分（visual analogue scale,VAS）、体动反应,以及术中需要追加丙泊酚、术后发生不良反应的例数。结果：与To时相比,各组T14时MAP降低,I组在T12时HR,SpO2降低（P〈0.05或0.01）。与Ⅱ组相比,I组恶心呕吐,呼吸抑制例数增多;Ⅲ组发生体动反应的例数及需要追加丙泊酚的例数增多（P〈0.01）;VAS评分Ⅰ组降低,而Ⅲ组则增高（P〈0.05）。结论：舒芬太尼鼻腔给药复合少量静脉注射用于宫腔镜手术病人的清醒镇痛,对呼吸循环影响小,镇痛效果好,不良反应少。Objective：To compare analgesia effects of intranasal and intravenous sufentanil in awake patients undergoing hysteroscopy.Methods：Sixty ASA I or II patients,aged（28～48） years,scheduled for elective hysteroscopy were randomly allocated to 3 groups（group I、II and III）（n=20 each）：group I received sufentanil 0.3μg /kg injected slowly iv;group II received sufentanil 0.1μg / kg injected slowly iv,and intranasal instillation of sufentanil 0.26μg /kg;group III received intranasal instillation of sufentanil 0.39μg /kg（Nasal drug,bioavailability of sufentanil up to 78%）.Patients with trauma or brain injury were not studied.Intermittent propofol 0.5～1.0 mg/kg was administered intravenously during operation when necessary.Values of MAP、HR、SpO2 and RR were continuously monitored and recorded before midazolam0.03 mg/kg administration（T0,baseline） and at（2,4,6,8） min after sufentanil administration（T1,2,3,4）.The level of analgesia was assessed using visual analogue scale（VAS）.Body movements in response to surgical stimuli,side effects,the amount of propofol used for analgesia or sedation were recorded.Results：The 3 groups were comparable with respect to age,body weight,height,and operation time.Compared with T0,the values of MAP was decreased at T14 in 3 groups and values of SpO2 and HR in group I were significantly lower at T12（P〈0.05 or 0.01）.Compared with group II,VAS scores in group I were lower,but higher in group III（P〈0.05）.In group I,cases of nausea and vomitting and respiratory depression increased（P〈0.05）.Occurrence of body movements and the amount of propofol showed significant increases in group III（P〈0.05）.Conclusion：Intranasal sufentanil,is safe and effective with less side effects,combined with a small amount of intravenous sufentanil in awake patients undergoing hysteroscopy.

关 键 词：舒芬太尼 给药 鼻内 宫腔镜手术 

分 类 号：R614.24[医药卫生—麻醉学]