舒芬太尼复合布托啡诺对依托咪酯全麻诱导肌震颤的影响  

Effect of sufentanil combined with butorphanol on etomidate-induced myoclonus during anesthesia induction

作　　者：高雪芳 邵新峰[2] Gao Xuefang;Shao Xinfeng

机构地区：[1]承德医学院,承德067000 [2]河北省保定市第一中心医院麻醉科,071000

出　　处：《中华普通外科学文献（电子版）》2020年第3期218-221,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的观察舒芬太尼复合布托啡诺对依托咪酯全麻诱导肌震颤的影响以及合适剂量。方法选择2018年11月至2019年6月河北省保定市第一中心医院择期行全麻手术患者120例,ASA Ⅰ~Ⅱ级,随机分为S组、BS1组和BS2组。S组静注舒芬太尼0.4 μg/kg;BS1组预注布托啡诺10 μg/kg,3 min后静注舒芬太尼0.3 μg/kg;BS2组预注布托啡诺20 μg/kg,3 min后静注舒芬太尼0.2 μg/kg,三组患者均于1 min后静注依托咪酯0.3 mg/kg(推注时间10~15 s)。连续观察2 min,静注顺苯磺酸阿曲库铵0.25 mg/kg,2 min后行气管插管。记录呛咳反应发生率,肌震颤发生情况,给药前、插管前即刻及插管后即刻的心率(HR)、平均动脉压(MAP),术后6 h内恶心呕吐的发生率。结果三组患者肌震颤的发生率无明显差异,S组呛咳反应的发生率高(χ^2=10.350,P=0.006);S组给药前至插管前即刻MAP、HR降低较BS1、BS2组明显(F=25.910、22.057,均P<0.001),BS1、BS2组间差异无统计学意义;插管前后BS1组HR、MAP升高最小,其次为S组,BS2升高最大(F=8.849、16.101,均P<0.001)。三组患者术中情况均稳定,术后均无严重的麻醉相关并发症。结论舒芬太尼复合布托啡诺与等效镇痛剂量的单纯舒芬太尼对于依托咪酯所致肌震颤的抑制作用相同,布托啡诺对舒芬太尼所致的呛咳反应具有抑制作用。布托啡诺10 μg/kg复合舒芬太尼0.3 μg/kg更能维持全麻患者气管插管血流动力学的稳定,为比较合适的麻醉诱导复合剂量。Objective To investigate the effect of sufentanil combined with butorphanol on etomidate-induced myoclonus during anesthesia induction and clinical appropriate dose.Methods One hundred and twenty patients (ASAⅠ-Ⅱ) undergoing general anesthesia admitted to Baoding NO.1 Central Hospital from November 2018 to June 2019 were randomly divided into group S,group BS1 and group BS2.According to the analgesic intensity and the peak time of efficacy of sufentanil and butorphanol,group S received sufentanil 0.4 μg/kg,group BS1 received butorphanol 10 μg/kg + sufentanil 0.3 μg/kg,and group BS2 received butorphanol 20 μg/kg + sufentanil 0.2 μg/kg.All patients were treated with etomidate 0.3 mg/kg 1 minute later (injection time 10-15 s).After two-minutes continuous observation,tracheal intubation was performed.The incidence of cough reaction and myoclonus were observed and the value of mean arterial pressure (MAP) and heart rate (HR) was recorded at the following time points:before administration,immediately before tracheal intubation and immediately after tracheal intubation.The incidence of sleepiness,nausea and vomiting within 6 hours after operation were recorded.Results There was no significant difference in the incidence of myoclonus among the three groups.The incidence of cough reaction in group S was higher than that in groups BS1 and BS2 (χ^2=10.350,P=0.006).The decrease of MAP and HR in group S before administration to intubation was more than that in groups BS1 and BS2 (F=25.910,22.057,both P<0.001),while there was no difference between group BS1 and group BS2.The increase of HR and MAP was the smallest in group BS1 before and after tracheal intubation,followed by that in group S,and the increase in group BS2 was the largest (F=8.849,16.101,both P<0.001).All patients successfully underwent the operation,and there were no serious anaesthesia related complications after operation.Conclusions The inhibitory effect of sufentanil combined with butorphanol is the same as sufentanil taken the same equivalent anal

关 键 词：布托啡诺 舒芬太尼 依托咪酯 肌震颤 

分 类 号：R614[医药卫生—麻醉学]