无肌松条件下舒芬太尼复合七氟醚麻醉诱导时的适宜剂量

Optimal dose of sufentanil combined with sevoflurane for general anesthesia induction in the absence muscle relaxant

目的探讨无肌松药条件下舒芬太尼复合七氟醚麻醉诱导的适宜剂量。方法择期全麻下行腹腔镜卵巢囊肿剥除术患者120例,根据七氟醚麻醉诱导时舒芬太尼用量不同(0.2、0.3、0.4、0.5μg/kg)随机分为四组(S1～S4组),每组30例。记录患者入室后10min(T0)、插管前即刻(T1)、插管后即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)、10min(T6)、术毕(T7)和拔管前1min(T8)的MAP和HR,并对各组的插管条件进行评分。结果四组插管评分S4组>S3组>S2组>S1组(P<0.05)。与T0时比较,T1时四组MAP下降、HR减慢(P<0.05),T2、T8时S1组MAP升高(P<0.05)。与S1组比较,T4～T6、T8时S2、S3、S4组MAP下降;与S2组比较,T2～T6时S3、S4组MAP下降(P<0.05)。S4组麻黄碱及阿托品用量多于S3组(P<0.05)。结论无肌松条件下,舒芬太尼0.4μg/kg复合七氟醚用于妇科手术麻醉诱导,能提供较好的插管条件和稳定的血流动力学。

Objective To explore the optimal dose of sufentanil combined with sevoflurane in the absence of muscle relaxant during general anesthesia induction.Methods A total of 120 patients undergoing elective laparoscopic oophorocystectomy were randomly divided into 4 groups with 30 cases each. The anesthesia was induced with sevoflurane and 0.2,0.3,0.4,0.5 μg/kg sufentanil（S1,S2,S3,S4 group）. Mean arterial pressure （MAP） and heart rate （HR） were measured at baseline （T0）,before intubation （T1）,1,3,5,10 min after intubation （T2-6）,at the end of surgery （T7）,and 1 min before extubation （T8）. Intubation scores were also recorded. Results The intubation scores were as the following sequence：S4 S3 S2 S1 （P0.05）. Compared with T0,MAP and HR decreased in each group at T1 while increased at T2,8 in group S1（P 0.05）. Compared with group S1,MAP was lower at T4-6,8 in groups S2-4 （P 0.05）. Compared with group S2,MAP was lower at T2-6 in groups S3,4 （P 0.05）. The consumption of ephedrine and atropine was more in group S4 than group S3 （P 0.05）. Conclusion Sufentanil 0.4 μg/kg combined with sevoflurane without muscle relaxant can provide excellent intubating conditions and stable hemodynamics during anesthesia induction in patients undergoing gynecologic surgery.