适宜剂量芬太尼用于鼻内镜手术非控制性降压麻醉中的临床观察

Clinical observation on appropriate dose of fentanyl in anesthesia without controlled hypotension for endoscopic sinus surgery

目的探讨适宜剂量芬太尼在鼻内镜手术非控制性降压麻醉中应用的有效性、可行性及安全性。方法选取择期行鼻内镜手术的患者45例,ASA分级I~Ⅱ级,年龄18~45岁,均经过规范化治疗控制炎症,采用随机数字表法分为3组,即Ι组、Ⅱ组和Ⅲ组。麻醉诱导时给予芬太尼3μg/kg,手术开始前Ι组追加芬太尼1.5μg/kg,Ⅱ组追加芬太尼2.5μg/kg,Ⅲ组追加芬太尼3.5μg/kg,连续监测血流动力学。观察并记录麻醉诱导前(T1)、手术开始时(T2)、手术开始15 min(T3)、手术开始30 min(T4)、鼻腔填塞医用PVA棉时(T5)患者的收缩压(SP)、舒张压(DP)、平均动脉压(MAP)、心率(HR)、心输出量(CO)、每搏量(SV)以及拔管时间和术后并发症,同一术者采用Fromme术野质量评分法(scores of surgical field quality,SSFQ)评定术野质量。结果与Ι组比较,Ⅱ组和Ⅲ组在T3、T4时点的MAP、HR、CO均低于Ι组,差异具有统计学意义(P<0.05);而Ⅱ组和Ⅲ组相比T3、T4时点的MAP、HR、CO无明显差异(P>0.05);术野质量SSFQ评分与Ι组比较,Ⅱ组和Ⅲ组的术野质量高于Ι组(P<0.05),Ⅱ组与Ⅲ组无明显差异;拔管时间比较Ι组与Ⅱ组无明显差异(P>0.05),Ⅲ组较Ⅱ组拔管时间延长有统计学意义(P<0.05);Ⅱ组未见明显不良反应。结论麻醉诱导时给予芬太尼3μg/kg,手术开始前追加芬太尼2.5μg/kg用于鼻内镜手术非控制性降压麻醉可使手术顺利完成,该方法有效且安全可行。

ObjectiveTo investigate the efficacy, feasibility and safety of appropriate dose of fentanyl in anesthesia without controlled hypotension for endoscopic sinus surgery.MethodsForty-five patients （ASA gradeⅠor Ⅱ degree, between the ages of 18 and 45, after standardized treatment to control inflammation） undergoing endoscopic sinus surgery were randomly assigned into three groups. During induction of anesthesia, intravenous injection of fentanyl 3 μg/kg was given to all patients in the three groups. Before the start of the operation, fentanyl of 1.5 μg/kg, 2.5 μg/kg and 3.5 μg/kg was supplemented to the group I, II and III respectively. Continuous hemodynamics monitoring was performed. At time-points before induction（T1）, at the beginning of operation（T2）, at 15 min （T3）, 30 min （T4）, and nasal packing （T5）, the hemodynamic parameters including systolic pressure （SP）, diastolic pressure （DP）, mean arterial pressure （MAP）, heart rate （HR）, stroke volume （SV） and cardiac output （CO） were recorded. Score of surgical field quality （SSFQ） was adopted to evaluate surgical field quality by the same surgeon. The extubation time and postoperative complications were also recorded.ResultsAt the time-points T3 and T4, the MAP, HR and CO of both group II and III were lower than those of the group I, their differences were all statistically significant （all P〈0.05）. Meanwhile, the differences between group II and III were all statistically insignificant （all P〉0.05）. The SSFQ scores of group II and III were higher than that of group I （both P〈0.05） while the difference between group II and III was insignificant （P〉0.05）. As for the extubation time, the difference between group I and group II was insignificant （P〉0.05） and that of group III was significantly prolonged （P〈0.05）. No obvious adverse reactions occurred in group II.ConclusionAnesthesia without controlled hypotension, given fentanyl 3 μg/kg in the induction of anesthesia and supplemented fentanyl 2.5 μg/kg prior to the start of surgery, can ensure the successful completion of endoscopic surgery. This anesthesia method is effective, safe and feasible.