舒芬太尼和芬太尼复合丙泊酚静脉全麻在隆乳术中的临床应用观察

Clinical Observation of Sufentanil and Fentanyl Combined with Propofol Intravenous Anesthesia in Breast Augmentation

目的比较舒芬太尼和芬太尼复合丙泊酚静脉全麻用于隆乳术的安全性和有效性。方法选择ASAⅠ～Ⅱ级门诊行隆乳术患者40例,年龄18～50岁,体质量42～55kg,随机分为两组,舒芬太尼复合丙泊酚组(S组)和芬太尼复合丙泊酚组(F组),每组20例。S组缓慢静注咪达唑仑0.02mg/kg,舒芬太尼0.2μg/kg,丙泊酚2.5mg/kg;F组缓慢静注咪达唑仑0.02mg/kg,芬太尼2μg/kg,丙泊酚2.5mg/kg。两组均待意识消失后开始局麻和手术。术中麻醉维持均以丙泊酚4～6mg/(kg.h)恒速静脉泵入。观察并记录麻醉前、切皮时、切皮后5、10、30min、术毕时MAP、HR、RR、SpO2的变化;术毕苏醒时间、术中记忆和术后不良反应。结果与麻醉前比较,切皮时两组MAP降低,HR减慢,P<0.05,差异有统计学意义;切皮后5、10、30min时S组的MAP和HR低于F组,P<0.05,差异有统计学意义;与麻醉前比较,切皮时、切皮后5、10min时两组的RR下降,P<0.05,差异有统计学意义;术后S组嗜睡率高于F组,P<0.05,差异有统计学意义。结论舒芬太尼(缓慢静注)复合丙泊酚可安全有效地用于隆乳术,效果优于芬太尼复合丙泊酚。

Objective To compare the efficacy of sufentanil and fentanyl combined with propofol intravenous anesthesia in breast augmentation. Methods Forty cases ASA Ⅰ～Ⅱ patients aged 18-50 years old,body mass 42 -55 kg undergoing breast operation were randomly allocated to two groups with 20 cases each. In group S, patients were induced slowly with midazolame 0.02 mg/kg,sufentanil 0.02 vg/kg,propofol 2.5 mg/kg. In group F, patients were induced slowly with midazolame 0.02 mg/kg, fentanyl 2/~g/kg, propofol 2.5 mg/kg. The operation began after loss of consciousness . The patients were maintained with propofol 4 6 mg/（kg h）. The variation of MAP, HR, RR,SpO2 before anesthesia and after incision 5,10,30 min and finishing the operation were observed and recorded. The effects of recovery and side effects after operation were observed as well. Results MAP and HR reduced at incision comparing before anesthesia（P〈0.05）. MAP and HR reduced in group S compared to group F after incision 5,10, 30 min（P〈0. 05）. RR reduced at incision and after incision 5, 10 min in two groups comparing before anesthesia（P〈0.05）. Patients in group S were more addicted to sleep than in group F after operation（P〈0.05）. Conclusion Sufentanil （iv slowly） combined with propofol is more safe and effective in breast augmentation than fentanyl combined with propofol.