芬太尼预防鼻咽部手术七氟醚全麻术后躁动

Intravenous fentanyl as a suppressant of agitation after ENT operations with sevoflurane general anesthesia

目的探讨芬太尼对鼻咽部手术七氟醚全麻术后躁动的预防作用。方法鼻咽部手术69例,美国麻醉医师协会(the American Society of Anesthesiologists,ASA)Ⅰ、Ⅱ级,随机分为3组,每组23例。均采用静吸复合全麻,七氟醚吸入诱导维持,麻醉用药相同。术毕停麻醉前10分钟分别静脉注射芬太尼1μg/kg(稀释1倍,Ⅰ组)、2μg/kg(Ⅱ组)或生理盐水体积等同于Ⅱ组(Ⅲ组,对照组)。观察各组术后躁动发生率、清醒情况、拔管时间及恶心和呕吐发生率。结果与对照组比较,Ⅰ、Ⅱ组拔管后躁动发生明显减少(P<0.05),Ⅱ组的拔管时间和苏醒时间长于对照组(P<0.05),恶心和呕吐发生率大于Ⅲ组(P<0.05)。结论静脉注射1μg/kg芬太尼可以减少鼻咽部手术七氟醚全麻术后躁动的发生,且不明显延长拔管苏醒时间,不增加术后恶心和呕吐发生率。

OBJECTIVE To investigate the effects of intravenously administration of fentanyl on agitation after ENT operation with sevoflurane general anesthesia. METHODS A total of 69 patients aged from 18 to 60 years underwent ENT operations were enrolled in this study. Anesthesia was induced with 8 % sevoflurance and vecuronium, and maintained with 2.5 %-3 % sevoflurane and N2O：O2 as 1：1. They were randomly given fentanyl 1μg/kg （group Ⅰ ）, 2μg/kg （group Ⅱ） or N.S with the volume same as group Ⅱ （group Ⅲ） intravenously after operation. The extubation time, waking time, postoperative agitation, nausea and vomiting were observed and recorded. RESULTS The agitation was remarkably suppressed in group Ⅰ and group Ⅱ. But the time of extubation and waking time was delayed in group Ⅱ compared with that in group Ⅰ. CONCLUSION Fentanyl 1 μg/kg can suppress the agitation of ENT operations induced and maintained by sevoflurane anesthesia and does not delay the time of extubation and waking or increase the rate of nausea and vomiting.