不同剂量舒芬太尼用于甲状腺手术的对比研究

Comparative effect of sufentanil with different concentrations in thyroid surgery

目的评价不同剂量舒芬太尼对甲状腺手术患者的镇静和镇痛效果。方法择期行甲状腺手术的60例患者随机分为三组：A、B、C组，每组各20例，分别于手术开始切皮前10min缓慢静脉推注舒芬太尼0．1、0．2、0．3μg／kg，然后以0．1μg／（kg·h）速度持续输注。记录三组患者在手术切皮时（T1）、术中牵拉甲状腺时（T2）及缝皮时（T3）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（spo2）、呼吸频率（RR）、镇静评分和镇痛评分，并进行比较。结果B、C组T1、T2Ramsay分级达Ⅳ级的例数（B组13、14例，C组14、15例）明显多于A组（7、10例）（P〈0．05），但B组与C组比较差异无统计学意义（P〉0．05）。B、C组视觉模拟评分（VAS）明显低于A组（P〈0．05）。A组T2MAP、HR与T_、L比较差异均有统计学意义（P〈0．05）；B和C组T1、T2MAP、HR与A组比较差异均有统计学意义（P〈0．05）；C组T2SpO2有所下降，但与A组和B组比较差异无统计学意义（P〉0．05）；C组T2RR与T1、B比较差异均有统计学意义（P〈0．05）。结论舒芬太尼可以安全有效地用于甲状腺手术中镇静和镇痛，以0．2μg／kg的负荷剂量持续输注效果更佳。

Objective To investigate the effects of sufentanil with different concentrations in patients control the sedative and analgesic in thyroid surgery. Methods Sixty patients with thyroid surgery were randomly equally divided into three groups before thyroidectomy： group A, group B and group C were respectively given 0.1, 0.2 and 0.3 μg/kg sufentanil by intravenous injection. At the infusion, 0.1 μ g/（ kg· h） sufentanil was administered. The mean arterial pressure （MAP）, heart rate （HR）, the pulse of oxygen saturation （SpO2） , respiratory rate （RR） , the sedation score and visual analogue scales （VAS） at the time of incision （T1）, upside pulling thyroid （T2 ） and seam skin （T3） were recorded. Results At T1 and T2, Ramsay 1V level in group B （ 13, 14 cases） and group C （ 14, 15 cases） were more than those in group A（7, 10 cases ）（P 〈 0.05 ）, but there were no significant difference between group B and group C （P 〉 0.05 ）. VAS in group B and group C was significantly lower than that in group A （P 〈 0.05 ）. At T2, the MAP and HR in group A compared with T1 and T3, there was significant difference （P〈 0.05 ）. At T1 and T2 the MAP and HR in group B and group C compared with group A, there was significant difference （P 〈 0.05）. Conclusion Sufentanil can be safe and effective for thyroid surgery and sedation analgesia, with loading dose of 0.2μg / kg, followed by 0.1 μ g / （kg·h） continuous infusion better effect.