舒芬太尼在日间腹腔镜胆囊切除术的临床应用

Application of sufentanil in the day-case laparoscopic cholecystectomy

目的:探讨舒芬太尼-七氟烷静吸复合麻醉在日间腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用价值。方法:将择期行日间LC的患者随机分为观察组与对照组,每组20例,观察组使用舒芬太尼(0.4μg/kg)进行麻醉,对照组使用芬太尼(4μg/kg)麻醉。观察两组患者麻醉期(术前到拔管)及术后生命体征(BP、HR、SPO2)、手术时间、苏醒时间、拔管时间、PACU躁动发生率及躁动程度、术后疼痛分级、术后镇痛药及麻醉并发症等指标。结果:两组患者麻醉诱导后血压、心率均较术前下降(P<0.05),组间相比差异无统计学意义(P>0.05);观察组苏醒时间及拔管时间、意识恢复时间、术后疼痛指数均优于对照组,差异有统计学意义(P<0.05);观察组PACU躁动发生率为5%,对照组为20%。结论:舒芬太尼较芬太尼在镇痛效果、镇痛时间、术后意识恢复、降低术后躁动发生率等方面具有一定优势,应用于日间LC的麻醉安全、有效。

Objective：To study the application of inhalation anesthesia with sufentanil-sevoflurane in the day-case laparoscopic cholecystectomy（LC）.Methods：Forty patients undergoing daytime LC were randomly divided into two groups for receiving anesthesia with sufentanil 0.4 μg/kg（sufentanil group,n=20）,or fentanyl 4 μg/kg（fentanyl group,n=20）.The vital signs（BP,HR,SPO2） of the two groups during anesthesia period and after operation were observed;moreover,operation time,analepsia time,extubation time,the incidence rate and degree of the restlessness in PACU,grade of postoperative pain,analgesic requirements and anesthesia complications were also observed.Results：The BP and HR were decreased after inductions in both groups（P0.05）,whereas there was no significant difference between two groups（P0.05）.The time of analepsia,extubation and consciousness recovery of sufentanil group was significantly less than that of the fentanyl group（P0.05）;the postoperative pain index of sufentanil group was significantly lower than that of the fentanyl group（P0.05）;the incidence of restlessness in PACU in sufentanil group was 5%,but 25% in fentanyl group.Conclusions：Compared with the fentanyl,the sufentanil has advantages in analgesic effect,analgesic time,consciousness recovery time and greatly decreases the rate of restlessness.The sufentanil anesthesia used for the day-case LC is safe and effective.