芬太尼或舒芬太尼喉罩全身麻醉下行经支气管镜超声引导针吸活组织检查术的临床观察  

Clinical observation of fentanyl or sufentanil used in general anesthesia assisted with laryngeal mask for endobronchial ultrasound-guided transbronchial needle aspiration

作　　者：唐富东[1] 程华春[1] 张慧君[1] 吕欣[1] 

机构地区：[1]同济大学附属上海市肺科医院麻醉科,上海200433

出　　处：《上海医学》2013年第6期494-497,共4页Shanghai Medical Journal

基　　金：上海市级医院适宜技术联合开发推广应用项目(SHDC12010214);上海市卫生局基金项目(20124342);国家自然科学基金(81272142)资助

摘　　要：目的观察芬太尼或舒芬太尼复合丙泊酚和琥珀酰胆碱全身麻醉用于经支气管镜超声引导针吸活组织检查术(EBUS-TBNA)的安全性和可行性。方法选择300例美国麻醉医师学会分级Ⅰ或Ⅱ级,年龄18～70岁,拟于全身麻醉下行EBUS-TBAN的患者,随机分入芬太尼组和舒芬太尼组,每组150例,分别采用芬太尼或舒芬太尼联合经静脉输液泵注射丙泊酚和琥珀酰胆碱辅助喉罩控制呼吸的方法。于麻醉诱导前(T0)、插入喉罩前(T1)、插入喉罩后(T2)、纤维支气管镜入气管时(T3),第1次针吸操作时(T4)、气管镜退出气管时(T5)、拔出喉罩后1min(T6)各时间点,记录患者的收缩血压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)。记录手术操作者满意度、麻醉医师满意度,及术后24h患者满意度,观察患者术后不良反应的发生情况。结果芬太尼组在T1和T2时间点的SBP、DBP均显著低于同组T0时间点(P值分别<0.01、0.05),T3至T5时间点的SBP、DBP均显著高于同组T0时间点(P值均<0.01);T2至T5时间点的HR均显著快于同组T0时间点(P值分别<0.01、0.05)。舒芬太尼组在T1和T2时间点的SBP、DBP,及T1至T6时间点的HR均显著低于同组T0时间点(P值分别<0.01、0.05)。芬太尼组在T1时间点的SBP、DBP均显著低于舒芬太尼组同时间点(P值均<0.05),T2至T5时间点的SBP均显著高于舒芬太尼组同时间点(P值分别<0.05、0.01),T3至T5时间点的DBP均显著高于舒芬太尼组同时间点(P值均<0.01);芬太尼组在T1至T5时间点的HR均显著快于舒芬太尼组同时间点(P值分别<0.05、0.01)。芬太尼组麻醉医师对麻醉效果不满意的构成比显著高于舒芬太尼组(P<0.01),两组间手术医师满意度和术后24h患者满意度构成比,以及术后不良反应发生率的差异均无统计学意义(P值均>0.05)。结论芬太尼或舒芬太尼复合经静脉输液泵注射丙泊酚和琥珀酰胆碱辅助喉罩控制呼吸的麻醉方法均能安全Objective To observe the safety and feasibility of general anesthesia performed with fentanyl or sufentanil combined with propofol and succinylcholine in endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA）. Methods Three hundred patients undergoing EBUS-TBNA under general anesthesia, American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ, aged 18-70 years, were randomly divided into fentanyl group and sufentanit group （n = 150）. EBUS-TBNA was performed under general anesthesia with fentanyl, propofo~ and succinylcholine assisted with laryngeal mask in fentanyl group. In sufentanil group, fentanyl was replaced by sufentanil. Systemic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, and pulse oxygen saturation （SpO2） were recorded before induction of anesthesia （T0）, before （T1） and after （T2） laryngeal mask was inserted, when bronchoscope was inserted （T3）, at the first time of transbronchial needle aspiration （T4）, when bronchescope was pulled out （T5）, and 1 min after laryngeal mask was pulled out （T6）. The satisfaction of operator, anesthesiologist and patients and the incidence of postoperative side effects were evaluated. Results In fentanyl group, SBP and DBP at T1 and T2 were significantly lower than those at To （P〈0.01, 0.05）, while SBP and DBP at T3, T4 and T5 were significantly higher than those at To （all P〈0. 01） ; HR from T2 to T5 was significantly increased as compared with that at To （ P〈0. 01, 0.05）. In sufentanil group, SBP and DBP at T1 and T2 and HR from T1 to T6 were significantly lower than those at To （P〈0.01, 0.05）. Compared with sufentanil group, SBP and DBP at T1 were significantly decreased in fentanyl group （both P〈0. 05）, SBP from T2 to T5, DBP from T3 to T5 and HR from T1 to T5 were significantly increased in fentanyl group （P〈0.05, 0.01）. The satisfaction of anesthesiologist for fentanyl group was significantly higher than sufentanil group （P〈0

关 键 词：经支气管镜超声引导针吸活组织检查术 全身麻醉 舒芬太尼 芬太尼 喉罩 

分 类 号：R614[医药卫生—麻醉学]