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

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

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、4μg/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(PETCO2),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PETCO2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。

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（PETCO2）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（P0.05-P0.01）,MAP of Group D dropped more than that of A,B and C（P0.05-P0.01）.HR of Group D was decreased temporarily（P0.05）.There was no statistically significant difference in the incidence of respiratory depression between Group A,B,C and D（P0.05）.SpO2 after induction was decreased slightly in Group D（P0.01）,while PETCO2 was increased（P0.05）.The induction time in Group A was longer than C and D（P0.05-P0.01）,and the awakening time was not different in the four groups（P0.05）.The dose of sevoflurane in Group C and D was lower than in A（P0.01）,the incidence of postoperative nausea and vomiting in Group A was higher than B,C and D（P0.05）.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.