不同剂量舒芬太尼对开颅手术患者苏醒期的影响

Effect of different doses of sufentanil on patients suffering from craniotomy awakening period

目的通过观察不同剂量舒芬太尼对开颅手术患者苏醒期的影响,探讨舒芬太尼用于脑科术后镇痛镇静的适宜剂量。方法选择择期行开颅手术患者80例,ASA分级Ⅰ-Ⅱ级,随机分为4组,S0、S1、S2和S3组,每组20例。在硬脑膜缝合结束时,S0组静脉输注生理盐水2 mL,而S1、S2和S3组分别静脉输注舒芬太尼2 mL（0.1μg/kg,0.15μg/kg,0.2μg/kg）,四组患者同时均给与帕瑞昔布钠40 mg。记录各组患者麻醉前T0、拔管前2 min（T1）、拔管即刻（T2）、拔管后1 min（T3）、拔管后5 min（T4）及拔管后10 min（T5）各时间点的平均动脉压、心率和脉搏血氧饱和度;记录拔管后5、10、30 min及拔管后1 h的VAS疼痛评分和Ramsay镇静评分;记录苏醒时间、拔管时间及围术期发生不良反应例数。结果对照组S0组在拔管时、拔管后1 min心率和平均运脉压比拔管前明显加快和增高,差异有统计学意义（P〈0.05）,S1组、S2组和S3组在拔管时、拔管后1 min、5 min比S0组增高幅度小,差异有统计学意义（P〈0.05）,而S3组比S1组和S2组增幅明显减小,差异有统计学意义（P〈0.05）,S3组拔管后10 min时基本稳定同术前和拔管前;只有S3组拔管后10 min SpO2明显降低,与拔管前及拔管后的其他三组比较差异有统计学意义（P〈0.05）;VAS评分用药组S1组、S2组和S3组与S0组比较各时间点均明显降低,差异有统计学意义（P〈0.05）;且S3组的VAS评分比S1和S2组各时间点也明显降低,差异有统计学意义（P〈0.05）;同时S3组镇静评分在拔管后比S0组、S1组和S2组明显增加,差异有统计学意义（P〈0.05）,呼吸抑制的发生率S3组比S0、S1和S2组明显增加,躁动发生率S1、S2和S3组比,S0组明显降低,术后寒颤S3组比S0组明显减少,恶心、呕吐方面各组无明显差异,术后躁动和寒颤的发生S1组、S2组和S3组间差异无统计学意义。结论三组舒芬太尼复合帕瑞昔布钠用于开颅手术苏醒期安全有效;舒芬太尼采用0.15μg/kg的剂量能维持较好的循环稳定,有效控制术后躁动的发生,且无明显的呼吸抑制、苏醒时间延长等不良反应,是较为安全有效的剂量。

Objective To investigate the effect of different doses of sufentanil on patients suffering from craniotomy during awakening period. Methods 80 patients of ASAⅠ ~ Ⅱ undergoing selective surgical operation were randomly divided into 4 groups,20 cases in each group. Group S0、group S1 、group S2 and group S3 was given 0. 9% normal saline,sufentanil 0. 1 μg /kg,0. 15 μg /kg and 0. 2 μg /kg respectively mixing with the same dose of parecoxib 40 mg when stitching dura mater. BP,HR and SpO2were recorded respectively before anesthesia（ T0）,2 min before extubation（ T1）,extubation immediately（ T2）,1 min after extubation（ T3）,5 min after extubation（ T4）,10 min after extubation（ T5）. Pain degree and the state of consciousness were evaluated 5 min,10 min,30 min and 1 h after extubation respectively with visual analogue scale（ VAS） and Ramsay sedation score. Awaking time and extubation time were recorded,and the incidence of adverse reactions were observed. Results HR was faster and MAP was higher when extubation and 1 min after extubation than before extubation in group S0（ P〈0. 05）; The degree of increase of HR and MAP in group S1,group S2and group S3 reduced significantly compared with group S0（ P〈0. 05）; The degree of increase in group S3 decreased than that in group S1 and group S2（ P〈0. 05）. The SpO2decreased significantly at 10 min after extubation in group S3 compared with before extubation and other groups（ P〈0. 05）. VAS score reduced significantly in group S1,group S2 and group S3 compared with group S0（ P〈0. 05）,and was the lowest in group S3. Ramsay sedation score and extubation time increased significantly in group S3 compared with group S0,group S1 and group S2（ P〈0. 05）. The incidence of shivering and mania increased significantly in group S0 compared with group S1,group S2 and group S3（ P〈0. 05）. Conclusion Using 3 kinds of doses of sufentanil mixed with parecoxib 40 mg for patients suffering from craniotomy when stitching dura mater are safe and effective during recovery period,and 0. 15 μg/kg of sufentanil has a better analgesic effect,high quality of awaking,less side effects,and can maintain circulation.