舒芬太尼两种不同给药模式对妇科腹腔镜术后患者麻醉恢复的影响

Two modes of sufentanil administration on anesthesia recovery in patients with gynecological laparoscopic surgery

目的探讨舒芬太尼两种不同给药模式对妇科腹腔镜术后患者麻醉恢复的影响。方法选择2009年3月—2012年2月收治的妇科行腹腔镜手术患者78例,根据舒芬太尼给药模式分为间断推药组和靶向控释组各39例,所有患者均采取气管全麻,麻醉前30 min肌内注射苯巴比妥钠0.1 g、阿托品0.15 mg。间断推药组:靶控输注异丙酚,患者意识消失后静脉推注舒芬太尼0.3μg/kg和维库溴铵0.1 mg/kg,并间断推注舒芬太尼;靶向控释组:靶控输注异丙酚的同时靶控输注舒芬太尼0.4μg/ml,意识消失后静脉推注维库溴铵0.1 mg/kg。比较两组患者的麻醉情况、麻醉恢复质量和Vas、Ramsay评分。结果舒芬太尼的使用量间断推药组(27.92±8.31)μg,靶向控释组(34.63±8.22)μg,两组比较差异有统计学意义(P<0.05);恢复自主呼吸时间、意识恢复时间、拔管时间,间断推药组分别为(7.32±2.83)min、(8.42±3.60)min、(10.35±4.51)min;靶向控释组分别为(11.33±4.24)min、(13.24±5.71)min、(16.48±7.58)min,两组比较差异均有统计学意义(均P<0.05)。且两组Ramsay评分比较差异有统计学意义(P<0.05)。结论舒芬太尼用于妇科腹腔镜手术患者,两种不同给药模式的镇痛和镇静作用均较强,间断推注给药患者苏醒更快,更为适宜。

Objective To discuss the effect of two modes of sufentanil administration on anesthesia recovery in patients with gynecological laparoscopic surgery. Methods From March 2009 to February 2012, 78 patients undergoing gynecologic laparoscopic surgery were randomly selected. Based on the mode of sufentanil administration, they were divided into two groups： intermittent bolus administration group and target-controlled administration group, 39 patients for each. All patients received endotracheal anesthesia, during whioh,pantobarbital sodium（0.1 g） and atropine（0.15 mg） were injected intramuscularly 30 min before anesthesia. For intermittent bolus administration group, after target-controlled infusion of propofol, the patients lost consciousness and then were given sufentanil 0.3 μ g/kg and vecuronium 0.1mg/kg intravenously, with intermittent bolus administration of sufentanil. For target-controlled administration group, after simultaneous target-controlled infusion of propofol and sufentanil （0.4 μg/ml）, the patients lost consciousness and then were given vecuronium 0.1 mg/kg intravenously. Both groups were compared for anesthetic effect, quality of recovery from anesthesia,VAS and Ramsay. Results The total dose of sufentanil was （27.92 ±8.31）μg in intermittent bolus administration group and（34.63 ± 8.22）ixg in target-controlled administration group, which showed significant difference （P〈0.05）. Time to restoration of spontaneous breathing, cohsciousness recovery time and time to extubation were（7.32 ±2.83） min,（8.42 ±3.60）min and（10.35 ± 4.51）min respectively in intermittent bolus administration group; and（t 1.33± 4.24）min,（13.24 ±5.71）min,（16.48 ± 7.58）min in target-controlled administration group. There was significant difference between the two groups （P〈0.05）.The Ramsay was different between the two groups（P〈0.05）. Conclusion Two modes of sufentanil administration in patients with gynecological laparoscopie surgery show potent analgesic and sedative effect, and intermittent bolus administration is more preferable for it leads to a faster wakeup after anesthesia.