骶管麻醉下小剂量氟哌利多复合芬太尼对选择性痔上黏膜切除钉合术中牵拉反射的影响  

Effect of Low-dose Droperidol Combined with Fentanyl Under Sacral Anesthesia on Traction Reflex During Tissue-selecting Therapy Stapler

作　　者：郝冬[1] 张锦[2] HAO Dong;ZHANG Jin(Department of Anesthesiology,Shenyang Intestinal and Anal Hospital,Shenyang 110002,China;Department of Anesthesiology,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China)

机构地区：[1]沈阳市肛肠医院麻醉科,辽宁沈阳110002 [2]中国医科大学附属盛京医院麻醉科,辽宁沈阳110004

出　　处：《中国医药指南》2020年第29期69-70,共2页Guide of China Medicine

摘　　要：目的观察骶管麻醉下小剂量氟哌利多复合芬太尼对选择性痔上黏膜切除钉合术(TST)术中牵拉反射的影响。方法选择我院收治的80例Ⅲ、Ⅳ期痔疮患者,均为美国麻醉医师协会(ASA)Ⅰ、Ⅱ级,年龄30~60岁,体质量50~80 kg,患者均行TST,随机分为A组与B组,每组40例。A组患者实施骶管麻醉+芬太尼+氟哌利多(骶管麻醉后静脉注射芬太尼0.001 mg/kg和氟哌利多0.025 mg/kg),B组患者实施骶管麻醉+咪达唑仑(骶管麻醉后静脉注射咪达唑仑0.05 mg/kg)。监测患者的生命体征。记录患者术中痔上黏膜切除钉合时的心率、血压变化以及恶心、呕吐发生率,使用视觉模拟评分法(VAS)评估患者下腹绞痛的程度。结果术中痔上黏膜切除钉合时,A组患者心率减慢、血压下降的发生率明显低于B组(P<0.05);A组患者恶心、呕吐的发生率也明显低于B组(P<0.05);A组患者的VAS评分明显低于B组(P<0.05)。结论骶管麻醉下小剂量氟哌利多复合芬太尼应用于TST,可明显减轻术中牵拉反射带来的不适感,提高患者舒适度。Objective To investigate low-dose droperidol combined with fentanyl under sacral anesthesia on traction reflex during tissue-selecting therapy stapler.Methods The 80 patients with stageⅢandⅣphase hemorrhoids admitted to our hospital,all of whom were American Society of Anesthesiologists(ASA)I andⅡ,aged 30-60 years,weighing 50-80 kg,all patients underwent TST,were randomly divided into group A and group B,40 cases in each group.Patients in group A received sacral anesthesia+fentanyl+droperidol(intravenous injection of fentanyl 0.001 mg/kg and droperidol 0.025 mg/kg after sacral anesthesia),patients in group B received sacral anesthesia+midazolam(intravenous injection midazolam 0.05 mg/kg after sacral anesthesia).Monitor the vital signs of patient.The changes of heart rate and blood pressure and the incidence of nausea and vomiting of patients during the operation of the hemorrhoid mucosal resection and nailing were recorded,and the Visual Analog Scale(VAS)was used to evaluate the degree of colic in the lower abdomen of patients.Results During intraoperative hemorrhoid resection and nailing,the incidence of heart rate slowdown and blood pressure drop in group A was significantly lower than that in group B(P<0.05);the incidence of nausea and vomiting in group A was also significantly lower than that in group B(P<0.05);the VAS score of group A was significantly lower than that of group B(P<0.05).Coclusion The application of low-dose droperidol combined with fentanyl to TST under sacral anesthesia can significantly reduce the discomfort caused by the traction reflex during the operation and improve the comfort of the patient.

关 键 词：痔疮 选择性痔上黏膜切除钉合术 骶管阻滞 氟哌利多 芬太尼 牵拉反射 

分 类 号：R657.18[医药卫生—外科学] R614[医药卫生—临床医学]