摘要
目的:比较芬太尼联合布托啡诺与单独使用芬太尼用于妇科腹腔镜术中对伤害性刺激的防治情况。方法:100例拟行气管插管全身麻醉的妇科腹腔镜手术患者,ASAⅠ或Ⅱ级,年龄18～45岁,随机均分为两组,芬太尼联合布托啡诺组(BF组)和芬太尼组(F组)。入手术室即给予心电(ECG)、心率(HR)、无创血压(BP)、血氧饱和度(SPO2)、末梢灌注指数(PI)、脑电双频指数(BIS)监测。观察两组患者在诱导前(T0)、诱导后插管前(T1)、气管插管即刻(T2)、切皮(T3)、二氧化碳气腹(CO2气腹)(T4)、牵拉腹膜(T5)、吸痰(T6)、拔管即刻(T7)各时点的BP和HR、SPO2、BIS、PI;诱导期呛咳及术后24 h恶心呕吐、声嘶、咽痛的发生情况,术毕BIS、呼吸恢复时间、睁眼时间、拔管时间及Ramsay镇静评分(RSS)、疼痛视觉模拟评分(VAS)、躁动评分(RS)。结果:BF组患者在插管即刻,切皮,牵拉腹膜,CO2气腹等强伤害性刺激时心率,平均动脉压较T1点虽有升高,PI较T1点略有降低,但差异无统计学意义;BIS值介于40～45;术毕BIS值BF组较F组低,PI值BF组较F组增高,P<0.05,RSS评分,RS评分,VAS评分,BF组均较F组偏低,P<0.05。呼吸恢复时间、睁眼时间、拔管时间BF组均较F组缩短,P<0.05,差异有统计学意义。结论:芬太尼联合布托啡诺在妇科腹腔镜全身麻醉中能有效抑制手术与麻醉导致的伤害性刺激,维持生命体征平稳;术后恢复迅速,短时间内即能恢复满意的自主呼吸和定向力。其残留镇痛作用,使患者术后无腹痛、腹胀,无恶心、呕吐等不适,不需加用术后镇痛泵,同时也节省了不良反应的治疗费用。较传统的阿片类药芬太尼单独应用有明显优势。
Objective:To compare the prevention and control of harmful stimulation when fentanyl with butorphanol and fentanyl were used for gynecological laparoscopic surgery.Methods:There were 100 cases scheduled for general anesthesia,gynecological laparoscopy patients,ASA Ⅰ or grade Ⅱ,aged from 18 to 45 years old,who were randomly divided into two groups,the fentanyl with butorphanol group(BF) and fentanyl(F) group.The patients going into operation room would be given the ECG,noninvasiveblood pressure,SPO2,PI,the BIS monitoring.Patients were observed before induction(T0),after induction before intubation(T1),endotracheal intubation(T2),skin incision(T3),CO2 pneumoperitoneum(T4),pulling the peritoneum(T5),suction(T6),extubation(T7) at each time point,BP and HR,SPO2,the BIS,PI;the BIS,breathing recovery time,time to eye opening,extubation time,and RSS,the VAS,the RS score after surgery;induction period's choke cough and 24 hours postoperative nausea and vomiting,hoar seness,sore throat occurrence.Results:BF patients in intubation,incision,pulling the peritoneum,CO2 gas abdomen and other strong harmful stimulation.Heart rate,mean arterial pressure compared with the induction of anesthesia although elevated,the P>0.05;peripheral perfusion index compared with induction of anesthesia decreased slightly,but P>0.05,bispectral index stabilized at 40~45.After surgery the BIS values of BF group is lower than the F,P<0.05.RSS score,RS score,VAS score,the BF group was lower than the F,P<0.05.Breathing recovery time,time to eye opening,extubation time,the BF group was much shorter than those in Group F,P<0.05.The difference was statistically significant.Conclusion:Fentanyl with butorphanol in gynecological laparoscopy under general anesthesia can effectively inhibit the harmful stimulation caused by surgery and anesthesia to maintain stable vital signs;can recover quickly after surgery,restore satisfactory spontaneous breathing and orientation.Because of residual analgesic effects,patients will have no abdominal pain,bloating,nausea,vomiting and other discomforts,have no additional postoperative analgesia pump,but also have no cost of treatment of adverse reactions.Compared with traditional opioid fentanyl alone,fentanyl with butorphanol has obvious advantage.
出处
《赣南医学院学报》
2013年第1期41-44,共4页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
江西省萍乡市科研课题项目
关键词
芬太尼
布托啡诺
腹腔镜
伤害性刺激
Fentanyl
Butorphanol
Laparoscopic
Harmful stimulation
