不同剂量舒芬太尼复合丙泊酚靶控输注在面部美容手术中的前瞻性随机对照研究  

A Prospective Comparison of Different Doses of Sufentanil Combined with Target Controlled Infusion of Propofol During Facial Plastic Surgery

作　　者：续飞[1] 王宽[1] 李琛 郭向阳[1] 王军[1] 李东[3] 

机构地区：[1]北京大学第三医院麻醉科,北京100191 [2]山东省烟台市中医院麻醉科,烟台264000 [3]北京大学第三医院成形外科,北京100191

出　　处：《中国微创外科杂志》2015年第9期777-780,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第三医院院内重点项目(课题号59437-02)

摘　　要：目的比较不同剂量舒芬太尼复合丙泊酚靶控输注用于面部美容手术的可行性和效果。方法 2014年8月-2015年2月,选择40例择期面部整形外科手术患者,ASAⅠ-Ⅱ级,用随机信封法分为2组,各20例。入室后静脉注射咪达唑仑0.03 mg/kg（T1）,再给予舒芬太尼0.1μg/kg（S1组）或0.2μg/kg（S2组）（T2）,然后靶控输注丙泊酚,观察术中体动和呼吸循环的变化以及对反复大声呼名无应答（T3）、注射局部麻醉药无体动反应（T4）、局部麻醉结束时的丙泊酚靶浓度（T5）,以及以上5个时点的平均动脉压（MAP）、心率（HR）、呼吸（RR）、脉搏血氧饱和度（Sp O2）。结果与T1相比,给予舒芬太尼后（T2）MAP无明显变化（P〉0.05）,但2组RR均明显下降（P=0.000、0.000）;复合丙泊酚靶控输注后（T3）,与T1相比,2组MAP均有明显下降（P=0.001、0.012）,且S1组更明显;与T1相比,Sp O2在S1组的T3（P=0.006）和S2组的T3（P=0.003）和T4（P=0.003）明显下降。S2组丙泊酚靶浓度在T3、T4和T5均明显低于S1组（P=0.042、0.000、0.000）,且体动反应发生率低（2/20 vs.14/20,χ^2=15.000,P=0.000）。结论舒芬太尼0.2μg/kg复合丙泊酚靶控输注能为面部美容手术提供满意的镇痛镇静效果,并能明显降低丙泊酚的靶浓度和术中体动发生率。Objective To compare the feasibility and the advantage of different doses of sufentanil combined with targetcontrolled infusion of propofol during facial plastic surgery. Methods A total of 40 ASA Ⅰ- Ⅱ patients undergoing facial plastic surgery from August 2014 to February 2015 were randomly allocated into two groups by using random envelops. Midazolam 0. 03 mg / kg（ T1） was used when patients arrived in the operating room,and then either sufentanil 0. 1 μg/kg（ group S1） or sufentanil 0. 2 μg/kg（ group S2） was given（ T2）. The propofol was infused by target controlled infusion pump. The target concentrations at the time when patients had no response to repeated and loud calling（ T3） and no body movement to local anesthetic injection（ T4）,and when local anesthetic injection ended（ T5）,were recorded,respectively. The MAP,HR,RR and Sp O2 at above mentioned 5 time points were also recorded. Results Sufentanil had no obvious affects on MAP（ P 〉0. 05）,but could significantly decrease the RR in both groups（ P = 0. 000 and 0. 000）. Sufentanil combined with target controlled infusion of propofol（ T3） could significantly decrease the MAP in the group S1 and group S2（ P = 0. 001 and 0. 012） as compared with T1,with the group S1 decreased more obviously. The Sp O2 was decreased obviously at T3 in the group S1（ P = 0. 006） and at T3（ P = 0. 003） and T4（ P = 0. 003） in the group S2 as compared with T1. The target concentrations in the group S2 at T3,T4 and T5（ P = 0. 042,0. 000,and 0. 000） were significant lower than that in the group S1; the incidence of the body movement in the group S2 was also lower than that in the group S1（ 2 /20 vs.14 /20,χ^2= 15. 000,P = 0. 000）. Conclusion Sufentanil 0. 2 μg / kg combined with target controlled infusion of propofol can provide satisfactory sedation and analgesia for facial plastic surgery,and can significantly decrease the target concentration of propofol and the incidence of body movement.

关 键 词：舒芬太尼 丙泊酚 靶控输注 面部美容手术 

分 类 号：R614.3[医药卫生—麻醉学]