面罩吸入七氟醚用于腰-硬联合麻醉时对镇静的影响  

Effects of inhalative sedation with sevoflurane in combined spinal-epidural anesthesia

作　　者：孙晓群[1] 徐红娟[1] 冯庆华[1] 倪加华 王超[1] 

机构地区：[1]江苏省扬中市人民医院麻醉科,212200

出　　处：《临床麻醉学杂志》2013年第2期144-147,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨腰-硬联合麻醉中面罩吸入七氟醚对镇静的影响。方法选择择期拟在椎管内联合麻醉下行妇科手术的患者60例,随机均分为Ⅰ、Ⅱ、Ⅲ三组,椎管内联合麻醉平面达到手术要求后进行镇静,镇静目标为OAA/S评分2～3分,BIS值65～85。Ⅰ组静脉给予氟-芬合剂1U(氟哌利多5mg、芬太尼0.1mg),每次追加1/3U;Ⅱ组静脉注射咪达唑仑40μg/kg,每次追加0.5mg,直至达到镇静目标;Ⅲ组吸入七氟醚,采用面罩肺活量吸入法诱导,睫毛反射消失后,置入口咽通气道,保留自主呼吸,吸入七氟醚维持上述镇静深度。监测患者麻醉前(T1)、麻醉平面达要求时(T2)、镇静后2min(T3)、10min(T4)、15min(T5)、1h(T6)、清醒时(T7)、回病房前(T8)的MAP、HR、SpO2、RR。记录术中用药情况,术后烦躁、恶心呕吐、呼吸抑制等不良反应的发生率;记录手术时间、苏醒时间、达到镇静目标时间,术后24h患者麻醉手术过程遗忘程度和满意度。结果 T3时Ⅲ组MAP明显低于Ⅰ组和Ⅱ组(P<0.05)。达到镇静目标时间Ⅲ组明显短于Ⅰ组和Ⅱ组(P<0.05)。遗忘程度达到2～3级的患者比例Ⅱ组和Ⅲ组明显多于Ⅰ组(P<0.01),对麻醉手术过程感到满意和非常满意百分比Ⅱ组和Ⅲ组明显高于Ⅰ组,且Ⅲ组明显高于Ⅱ组(P<0.01或P<0.05)。结论椎管内联合麻醉中静脉给予咪达唑仑、面罩吸入七氟醚能提供有效的镇静,对呼吸循环影响小;而面罩吸入七氟醚,镇静起效快、恢复迅速、患者满意度高。Objective To investigate the effects of inhaling sevoflurane for sedation in combined spinal-epidural anesthesia. Methods Sixty patients undergoing selective gynecological surgery, were randomly divided into three groups, with 20 patients in each group. After combined spinal-epidural anesthesia meet the demand of surgery, three different sedation methods were performed to achieve the OAA/S score 2-3 or BIS value 65-85. Group Ⅰ ： intravenous injection innovar 1 U（droperidol 5 mg, fentanyl 0. 1 mg）, additional 1/3 innovar for each time. Group Ⅱ ： intravenous injection midazolam 40 μg/kg, then given another 0.5 mg for each time. Group Ⅲ ： after eyelash flex disappeared by vital capacity inhalation induction with sevoflurane, oropharyngeal tube were put in, maintaining spontaneous breathing by sevoflurane. We monitored MAP, HR, SpO2 and RR in eight time points , as before anesthesia （T1）, after combined spinal-epidural anesthesia （T2）, 2 rain after sedation （Ta）, 10 rain after sedation （T4）, 15 rain after sedation （Ts）, 1 h after sedation （T6）, awake （T7）, and the time back to the ward （T8）. Cases of dysphoria, nausea, vomiting and respiratory depression during and after operation were recorded. We also followed up the satisfaction and memory classification of patients about anesthesia and surgery during 24 h after operation. Results Compared with patients in groups Ⅰ and Ⅱ, MAP in group Ⅲ was significantly lower at T3 （P〈0. 05）. As referring to the time achieving sedation, group Ⅲ was less than that in groups Ⅰ and Ⅱ （P〈0. 05）. Number of patients achieve 2-3 grade amnesia in groupⅢand Ⅲ were significantly larger than in group Ⅰ （P〈0.01）, no difference between group Ⅲ and Ⅲ. The percentage of great and general satisfaction to anesthesia in groups Ⅱ and Ⅲ were higher than that in group Ⅰ , and group Ⅲ were higher than group Ⅱ（P〈0.01 or P〈0.05）. Conclusion Intravenous injection of midazolam or inhaling sevoflurane

关 键 词：七氟醚 镇静 椎管内联合麻醉 咪达唑仑 氟-芬合剂 

分 类 号：R614[医药卫生—麻醉学]