小剂量舒芬太尼经鼻黏膜给药在局部麻醉手术中的应用

Intranasal low dosage sufentanil used in operation under local anesthesia

目的观察在局部麻醉手术中经鼻黏膜滴入舒芬太尼所产生的辅助镇痛效果。方法82例局部麻醉下行单侧甲状腺腺瘤切除术患者，随机分为两组（观察组和对照组），每组各41例。观察组切皮前10min经鼻黏膜滴入舒芬太尼20μg，以0．5％利多卡因局部浸润后开始手术；对照组用注射用水作为安慰剂替代舒芬太尼，其余相同。术中采用语言评定量表（VRS）进行疼痛评分，记录患者经鼻给药前及给药后5、10、20、40、60min的无创血压（NBP）、HR、SpO2和呼吸频率（RR），术后记录所用局部麻醉药总量、手术时间、甲状腺腺瘤大小和患者满意度。观察术中、术后可能出现的不良反应，如恶心呕吐、皮肤瘙痒等。结果两组患者均顺利完成手术，术中血流动：匀学稳定。观察组患者的RR在给药后10、20、40min时明显减慢，分别为（13．1±0．5）、（13．8±0．6）、（13．8±0．8）次／min，与给药前比较差异有统计学意义（P〈0．05），60min时恢复至给药前水平。在剥离甲状腺时，观察组患者的VRS评分为（2．0±0．4）分，明显低于对照组[（4．5±0．6）分]，差异有统计学意义（P〈0．05）。手术过程中观察组患者所用局部麻醉药总量为（42．5±6．9）ml，对照组为（63．7±4．3）ml，两组比较差异有统计学意义（P〈0．05）。两组患者术中镇痛满意度比较差异有统计学意义（P〈0．05）。结论小剂量舒芬太尼经鼻黏膜给药具有良好的镇痛效果，可安全应用于局部麻醉手术中辅助镇痛。

Objective To observe effects of intranasal sufentanil on analgesia. Methods Eighty-two patients, who scheduled for selective thyroidectomy were randomly divided into the observed group and the control group with 41 cases in each group. In tile observed group, patients received intranasal sufentanil 20 μg before the incision about 10 minutes, then administered local infiltration with 0.5% lidocaine. In the control group, patients received water for injection which was placebo instead sufentanil. By double blind method observed verbal rating scale （VRS） score. The values of NBP, HR, SpO2 and respiration rate （RR）were recorded before intranasal drugs and 5, 10, 20, 40, 60 min after intranasal drugs： The amount of local anesthetic, the size of thyroid gland, the time of operation and the satisfaction were compared between the two groups. Nausea vomiting and pruritus were also observed in order to assess the safety of intranasal sufentanil. Results All patients completed the operation successfully. The RR in the observed group decreased to （13.1 ± 0.5）, （13.8 ± 0.6）, （13.8 ± 0.8） times/min after intranasal sufentanil 10, 20, 40 min, and had significant difference with those before intranasal drugs （P 〈 0.05 ）, anastated after 60 min. VRS score of the observed group was （2.0 ± 0.4） scales, less than the control group, and had significant difference when the surgeon was dissecting thyroid gland （P 〈 0.05 ）. The amount of local anesthetic in the observed group was（42.5 ± 6.9 ）ml, less than the control group （63.7 ± 4.3 ）ml （P 〈 0.05 ）. The satisfaction had significant difference between the two groups（P 〈 0.05 ）. Conclusion Intranasal sufentanil for analgesia is a safe and useful technology.