舒芬太尼和芬太尼应用于腹腔镜胆囊切除术患者苏醒质量的比较

The comparison of the quality of recovery from general anesthesia with sufentanil and fentanyl on laparoscopic cholecystectomy

目的:比较舒芬太尼和芬太尼与七氟醚复合应用于腹腔镜胆囊切除术患者术后苏醒质量的差异。方法:选择在南通大学附属海安医院行择期妇科腹腔镜手术的患者50例,平均分为两组:舒芬太尼组(S组)芬太尼组(F组)各25例。给予全身麻醉诱导:S组和F组患者分别推注舒芬太尼0.4μg/kg和芬太尼3μg/kg,同时推注咪达唑仑0.05 mg/kg、苯磺顺阿曲库铵0.15 mg/kg、丙泊酚2 mg/kg。术中S组和F组分别以舒芬太尼0.5μg/(kg·h)和芬太尼1.5μg/(kg·h)经推注泵注射,所有患者术中复合吸入1.5%~2.0%七氟醚维持麻醉,关气腹时停止所有静、吸麻醉药物。记录患者麻醉停药至自主呼吸恢复时间、睁眼时间、指令反应恢复时间、拔除气管导管时间;统计患者围拔管期并发症及不良反应发生情况;评定患者拔管后30 min的Ramsay清醒评分;对患者拔管后5 min、20 min、1 h和2 h进行疼痛评分(VAS)。结果:1S组患者各项苏醒指标比F组略长,差异无统计学意义(P﹥0.05);F组患者术后躁动的发生率高于S组(P﹤0.05)。2与F组相比,S组Ramsay评级为1的患者明显偏少(P﹤0.05);S组患者在拔管后5 min、30 min、1 h的VAS评分均比R组低,差异具有统计学意义(P﹤0.05);3两组患者围拔管期发生各种不良反应的机率均较低,舒芬太尼组有呼吸抑制发生。结论:舒芬太尼和芬太尼均可使患者快速安全苏醒,术后不良反应发生率均较低。舒芬太尼在降低拔管后切口疼痛、躁动的发生率方面优于芬太尼,但需注意术后呼吸抑制。

Objective To observe the quality of recovery from anesthesia with sevoflurane combined sufentanil and fentanyl on gynaecologic loparoscopy operation. Method Fifty patients undergoing laparoscopic cholecystectomy were selected,Patients were divided into two groups randomely： group S（ sufentanil） and F（ fentanyl）,each group had 25 patients. Anesthesia of the two groups were induced with sufentanil 0. 4 μg/kg or fentanyl 3 μg/kg,and midazolam 0. 05 mg/kg、cisatracurium besylate 0. 15 mg/kg ﹑ propofol 2 mg/kg. All the patients inhaled sevoflurane of 1. 5% ~ 2. 0% at the same time,patients in two groups were infused with sufentanil 0. 5 μg/（ kg·h） or fentanyl 1. 5 μg/（ kg·h）,and they were stoped infusion at the time of stoping pneumoperitoneum. The following were recorded and compared： The duration from termination of surgery to full recovery of spontaneously breathing,eye opening,response to instruction and traeheal extubation; Postoperative complications. Ramsay score 30 minutes after extubation; VAS score at the time points： 5 minutes after extubation,20 minutes after extubation,1 hour after extubation and 2 hours after extubation. Results 1There were no statistics difference of the duration from termination of surgery to full recovery of spontaneously breathing,eye opening,response to instructionand tracheal extubation In both groups（ P〈0. 05）,the incidence of postoperative agitation in group S was higher than that in group F（ P〈0. 05）; 2The patients of firstgrade of Ramsay score were fewer in group S than in group F（ P〈0. 05）; VAS scoresat 5 minutes after extubation,20 minutes after extubation and1 hour after extubation in group S were signifieantly lower than those in group F,the difference was statistically significant（ P〈0. 05）;（3）The side effect during the recovery period of general anesthesia in both groups are low. Conclusion All patients in both groups could recovery from general anesthesia quickly and safely,the side effect during the recovery period of general anesthesia in both groups were low. Sufentanil could reduce the incidence of postoperative pain and restlessness. But the respiratory depression need to pay attention.