芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜气压弹道碎石术效果观察

郑立东; 李仁虎; 吴庆玲

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芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜气压弹道碎石术效果观察

郑立东 , 李仁虎 , 吴庆玲

文章导航 > 蚌埠医学院学报 > 2011, 36 > 7: (701-704)

引用本文:

Citation:

芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜气压弹道碎石术效果观察

安徽医科大学附属六安医院麻醉科, 安徽六安 237005

作者简介: 郑立东(1966-),男,副主任医师.

中图分类号: R614.21

Application of intravenous fentanyl combined sevoflurane inhalational anesthesia by laryngeal mask airway in the ureteroscope pneumatic lithotripsy

Department of Anesthesiology, Affliated Lu'an Hospital of Anhui Medical University, Lu'an Anhui 237005, China
CLC number: R614.21

摘要: 目的: 比较不同剂量芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜下气压弹道碎石术(URSL)的麻醉效果及安全性。方法: 将ASAⅠ~Ⅱ级择期行URSL患者80例随机分为4组,每组20例。A组单纯七氟烷吸入麻醉,B、C、D 3组于七氟烷吸入诱导前2 min分别静脉注射芬太尼1、2、4 μg/kg,4组患者均成功置入喉罩,七氟烷持续吸入。麻醉过程中持续监测心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO₂)、呼气末二氧化碳分压(P_ET CO₂),并记录诱导时间、苏醒时间、术中用药、肢动情况,观察有无呼吸抑制、术后头晕、恶心、呕吐等并发症。结果: 4组患者均能顺利完成手术,无术中知晓发生。麻醉诱导后4组患者MAP均有所下降(P < 0.05~P < 0.01),D组均较A、B、C组下降(P < 0.05~P < 0.01)。D组在T₃~T₆诱导后HR一过性下降(P < 0.05)。麻醉及术中除D组外呼吸抑制发生差异无统计学意义(P > 0.05),D组SpO₂在吸入诱导后较麻醉前有所下降(P < 0.01)。D组P_ETCO₂较麻醉前升高(P < 0.05)。诱导时间A组长于C、D组(P < 0.05~P < 0.01),苏醒时间4组差异无统计学意义(P > 0.05)。术中七氟烷的用量C、D组少于A组(P < 0.01),术后恶心、呕吐后的发生率A组高于B、C、D组(P < 0.05)。A、B组置入喉罩时及术中有肢动发生。结论: 七氟烷经喉罩吸入在URSL中麻醉效果确切、安全。七氟烷吸入诱导前2 min静脉注射芬太尼,可以缩短诱导时间,减少七氟烷的用量及副作用。只有当芬太尼用量达到或超过4μg/kg时对呼吸、循环才产生影响。
- 麻醉,吸入 /
- 芬太尼 /
- 七氟烷 /
- 输尿管镜气压弹道碎石术 /
- 喉罩
Abstract: Objective: To compare the anesthesia effects and security of different dose of fentanyl injection combined sevflurance inhalational anesthesia by larygeal mask airway(LMA) in the ureteroscope pneumatic lithotripsy(URSL). Methods: Eighty patients, classified ASA Ⅰ-Ⅱ,scheduled for the selective surgery of URSL,were randomly divided into four groups with 20 cases each. Group A was given total sevoflurane inhalational anesthesia, Group B、C、D received intravenous fentanyl 1,2 and 4 μg/kg respectively, 2 minutes before sevflurance inhalational anesthesia induction was implemented. The vital signs such as heart rate(HR)、mean arterial pressure(MAP),arterial oxygen saturation(SpO₂) and end-tidal pressure of carbon dioxide(P_ETCO₂) were monitored during anesthesia, and induction time, awakening time, intraoperative medication, body motion were recorded. Meanwhile, the complications such as respiratory depression, postoperative dizziness, nausea and vomiting were observed. Results: Four groups underwent the operation smoothly,and awareness with recall during general anesthesia didn't occur. After induction,MAP of four groups declined (P < 0.05-P < 0.01),MAP of Group D dropped more than that of A,B and C(P <0.05-P <0.01). HR of Group D was decreased temporarily (P < 0.05). There was no statistically significant difference in the incidence of respiratory depression between Group A,B,C and D(P > 0.05). SpO₂ after induction was decreased slightly in Group D(P < 0.01),while P_ETCO₂ was increased(P < 0.05). The induction time in Group A was longer than C and D(P < 0.05-P < 0.01),and the awakening time was not different in the four groups(P > 0.05). The dose of sevoflurane in Group C and D was lower than in A(P < 0.01),the incidence of postoperative nausea and vomiting in Group A was higher than B,C and D(P < 0.05). When the LMA was inserted,there was body motion happened in A and B. Conclusions: The application of fentanyl injection combined sevoflurane inhalational anesthesia by LMA in the URSL is effective and safe. Fentanyl wes given 2 minutes before sevflurance inhalational anesthesia induction,which can shorten the induct time,lower the dose and side effects of sevflurance. When the dose of fentanyl is or over 4 μg/kg,the influence of respiration and circulation will happen.
- anesthesia,inhalation /
- fentanyl /
- sevoflurane /
- ureteroscope pneumatic lithotripsy /
- laryngeal mask airway

[1]	纵春华 . 舒芬太尼与芬太尼用于小儿七氟烷全麻下扁桃体切除术苏醒期躁动的疗效比较. 蚌埠医学院学报, 2014, 39(9): 1201-1203.
[2]	雷剑 , 孙新朝 , 汪宝军 . 全凭静脉联合喉罩七氟醚吸入麻醉在腹腔镜辅助阴式子宫全切术中的应用. 蚌埠医学院学报, 2018, 43(11): 1478-1480. doi: 10.13898/j.cnki.issn.1000-2200.2018.11.024
[3]	郭文斌 , 扬庆耿 . 不同剂量瑞芬太尼对小儿七氟烷麻醉下自主呼吸的影响分析. 蚌埠医学院学报, 2016, 41(7): 879-881. doi: 10.13898/j.cnki.issn.1000-2200.2016.07.013
[4]	王娟 , 王涛 , 王昌合 , 臧学利 , 赵强 . 腹腔镜手术应用喉罩时麻醉质量控制中术者积极参与的效果观察. 蚌埠医学院学报, 2016, 41(6): 736-738. doi: 10.13898/j.cnki.issn.1000-2200.2016.06.010
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[6]	余清 . 丙泊酚与七氟烷麻醉对骨科老年手术患者术后认知功能的影响. 蚌埠医学院学报, 2013, 37(8): 982-984.
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[8]	陈龙 , 张茂银 , 耿兴云 . 丙泊酚靶控复合吸入低浓度异氟烷在小儿短小手术中的应用. 蚌埠医学院学报, 2007, 32(6): 720-722.
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[13]	郭芳 . 瑞芬太尼和芬太尼用于老年患者开胸手术麻醉的比较. 蚌埠医学院学报, 2009, 34(4): 327-329.
[14]	李克寒 , 杨惠敏 , 郭丹 . 瑞芬太尼或不同剂量地佐辛全麻诱导期喉罩置入对丙泊酚半数有效血浆靶浓度的影响. 蚌埠医学院学报, 2016, 41(10): 1299-1301,1305. doi: 10.13898/j.cnki.issn.1000-2200.2016.10.013
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芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜气压弹道碎石术效果观察

作者简介: 郑立东(1966-),男,副主任医师.

安徽医科大学附属六安医院麻醉科, 安徽六安 237005

收稿日期: 2010-10-15

关键词:

摘要: 目的: 比较不同剂量芬太尼静脉注射复合七氟烷经喉罩吸入用于输尿管镜下气压弹道碎石术(URSL)的麻醉效果及安全性。方法: 将ASAⅠ~Ⅱ级择期行URSL患者80例随机分为4组,每组20例。A组单纯七氟烷吸入麻醉,B、C、D 3组于七氟烷吸入诱导前2 min分别静脉注射芬太尼1、2、4 μg/kg,4组患者均成功置入喉罩,七氟烷持续吸入。麻醉过程中持续监测心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO₂)、呼气末二氧化碳分压(P_ET CO₂),并记录诱导时间、苏醒时间、术中用药、肢动情况,观察有无呼吸抑制、术后头晕、恶心、呕吐等并发症。结果: 4组患者均能顺利完成手术,无术中知晓发生。麻醉诱导后4组患者MAP均有所下降(P < 0.05~P < 0.01),D组均较A、B、C组下降(P < 0.05~P < 0.01)。D组在T₃~T₆诱导后HR一过性下降(P < 0.05)。麻醉及术中除D组外呼吸抑制发生差异无统计学意义(P > 0.05),D组SpO₂在吸入诱导后较麻醉前有所下降(P < 0.01)。D组P_ETCO₂较麻醉前升高(P < 0.05)。诱导时间A组长于C、D组(P < 0.05~P < 0.01),苏醒时间4组差异无统计学意义(P > 0.05)。术中七氟烷的用量C、D组少于A组(P < 0.01),术后恶心、呕吐后的发生率A组高于B、C、D组(P < 0.05)。A、B组置入喉罩时及术中有肢动发生。结论: 七氟烷经喉罩吸入在URSL中麻醉效果确切、安全。七氟烷吸入诱导前2 min静脉注射芬太尼,可以缩短诱导时间,减少七氟烷的用量及副作用。只有当芬太尼用量达到或超过4μg/kg时对呼吸、循环才产生影响。

English Abstract

Application of intravenous fentanyl combined sevoflurane inhalational anesthesia by laryngeal mask airway in the ureteroscope pneumatic lithotripsy

Department of Anesthesiology, Affliated Lu'an Hospital of Anhui Medical University, Lu'an Anhui 237005, China

Received Date: 2010-10-15

Abstract: Objective: To compare the anesthesia effects and security of different dose of fentanyl injection combined sevflurance inhalational anesthesia by larygeal mask airway(LMA) in the ureteroscope pneumatic lithotripsy(URSL). Methods: Eighty patients, classified ASA Ⅰ-Ⅱ,scheduled for the selective surgery of URSL,were randomly divided into four groups with 20 cases each. Group A was given total sevoflurane inhalational anesthesia, Group B、C、D received intravenous fentanyl 1,2 and 4 μg/kg respectively, 2 minutes before sevflurance inhalational anesthesia induction was implemented. The vital signs such as heart rate(HR)、mean arterial pressure(MAP),arterial oxygen saturation(SpO₂) and end-tidal pressure of carbon dioxide(P_ETCO₂) were monitored during anesthesia, and induction time, awakening time, intraoperative medication, body motion were recorded. Meanwhile, the complications such as respiratory depression, postoperative dizziness, nausea and vomiting were observed. Results: Four groups underwent the operation smoothly,and awareness with recall during general anesthesia didn't occur. After induction,MAP of four groups declined (P < 0.05-P < 0.01),MAP of Group D dropped more than that of A,B and C(P <0.05-P <0.01). HR of Group D was decreased temporarily (P < 0.05). There was no statistically significant difference in the incidence of respiratory depression between Group A,B,C and D(P > 0.05). SpO₂ after induction was decreased slightly in Group D(P < 0.01),while P_ETCO₂ was increased(P < 0.05). The induction time in Group A was longer than C and D(P < 0.05-P < 0.01),and the awakening time was not different in the four groups(P > 0.05). The dose of sevoflurane in Group C and D was lower than in A(P < 0.01),the incidence of postoperative nausea and vomiting in Group A was higher than B,C and D(P < 0.05). When the LMA was inserted,there was body motion happened in A and B. Conclusions: The application of fentanyl injection combined sevoflurane inhalational anesthesia by LMA in the URSL is effective and safe. Fentanyl wes given 2 minutes before sevflurance inhalational anesthesia induction,which can shorten the induct time,lower the dose and side effects of sevflurance. When the dose of fentanyl is or over 4 μg/kg,the influence of respiration and circulation will happen.