纳美芬在人工流产舒芬太尼复合丙泊酚麻醉中的应用

The application of nalmefene in sufentanil and propofol anesthesia for abortion

目的:探讨纳美芬用于人工流产舒芬太尼复合丙泊酚麻醉中的疗效及其对BIS值的影响。方法:120例接受人工流产手术患者,随机分为A、B、C、D四组(n=30):A、B组分别予舒芬太尼0.2μg/kg、0.3μg/kg后复合丙泊酚1.5 mg/kg诱导麻醉;C、D组麻醉前静注纳美芬0.2μg/kg后分别同A、B组进行诱导。根据BIS值及血流动力学的波动来调整丙泊酚的用量,必要时单次静脉追加丙泊酚0.5 mg/kg。观察并记录患者注药前(T1)、睫毛反射消失时(T2)、扩宫(T3)、人流手术操作(T4)、术毕清醒时(T5)等时刻的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)和呼吸频率(RR),同时记录各组丙泊酚追加量、手术时间、术毕苏醒时间、术毕1 min定向力恢复Steward评分、术中体动反应、呛咳、呼吸抑制等不良反应发生率、术后15 min视觉模拟数字评分(VAS)等。结果:与A组比较,B、D组丙泊酚追加量减少,术中体动反应发生率低,术后VAS低(P<0.05),C组与A组无明显差异(P>0.05);B、C、D组苏醒快,术毕1 min内定向力恢复较A组评分高(P<0.05),其中D组定向力恢复评分明显高于B组(P<0.05);A、B组呼吸抑制及呛咳发生率高于C、D组(P<0.05)。结论:术前使用纳美芬0.2μg/kg可有效拮抗无痛人流中舒芬太尼引起的呼吸抑制、苏醒延迟等不良反应,该剂量在本研究中未观察到增强镇痛的效果,未发现其影响BIS的改变。

Objective To investigate the effect of nalmefene on sufentanil and propofol anesthesia for abortion and its impact on BIS. Methods One hundred and twenty patients undergoing abortion patients were randomly divided into group A, B, C, and D （n = 30 each）. Patients in group A and B received 0.2 μg/kg or 0.3 μg/kg sufentanil, respectively, followed with 1.5 mg/kg propofol for induction of anesthesia post- pretreatment with 0.2 μg/kg nalmefene. Patients in group C and D received induction of anesthesia as patients in group A and B. According to the BIS and fluctuation of hemodynamie, the amount of propofol was adjusted. If necessary, additional single intravenous injection of 0.5 mg/kg propofol. The mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpOz） and respiratory rate （RR） in patient before injection （T1）, the eyelash reflex （T2）, dilatation （T3）, curettage （T4） and surgery awake （T5） were detected. The additional amount of propofol, operation time, recovery time of surgery, the steward score of orientation recovery after lmin of surgery, body movement reaction, cough, respiratory depression, postoperative visual analog digital score （VAS） 15 min later were also recorded in each group. Results Compared with group A, propofol could reduce the intraoperative body movement reaction rate, with lower postoperative VAS in group B and group D （P 〈 0.05, respectively）, with no significant difference between group C and group A （P 〉 0.05）. The rapid recovery, surgery within 1 min orientation recovery were higher in group B, C, D compared with group A （P 〈 0.05）. However, orientation recovery score in group D was higher than that in group B （P 〈 0.05） ; The respiratory depression and choking were higher in group A and B than those in group C, D （P 〈 0.05, respectively）. Conclusion The doses of 0.2 μg/kg nalmefene can effectively antagonize the respiratory depression, delay recovery and other adverse reactions in painless which induced by sufentanil, and the dose of nalmefene in this study failed to enhance the effect of analgesic and change the BIS values.