纳布啡与舒芬太尼在喉罩置入全麻下行腹腔镜卵巢囊肿挖除术时的应用比较

Comparison of nalbuphine and sufentanil used for laryngeal mask insertion under the general anaesthesia during laparoscopic oophorocystectomy

目的比较纳布啡与舒芬太尼在喉罩置入全麻下行腹腔镜卵巢挖除术的临床应用效果。方法择期行腹腔镜卵巢囊肿挖除术患者80例随机分为两组,入室后依次给予咪达唑仑0.05 mg/kg,纳布啡(N组)0.3 mg/kg或舒芬太尼(S组)0.3μg/kg,丙泊酚1.5 mg/kg,罗库溴铵0.6 mg/kg,90 s后行喉罩置入。术毕入复苏室待自然苏醒后拔除喉罩。记录基础值T0、喉罩置入前即刻(T1),置入后1 min(T2),置入后5 min(T3),拔除喉罩前即刻(T4),拔除喉罩后5 min(T5)的SBP、DBP、HR值,记录各组患者拔除喉罩时间、复苏室滞留时间,记录离开复苏室时的VAS评分,并观察各组患者恶心、呕吐、眩晕、嗜睡、呼吸抑制等不良反应的发生情况。结果与T0比较,在T1时刻,S组患者SBP、DBP、HR下降差异有统计学意义(P<0.05),N组无明显变化(P>0.05)。与T0比较,T2、T3、T4、T5时刻两组患者SBP、DBP、HR变化不大(P>0.05)。两组间比较,在T1时刻,S组患者SBP、DBP、HR明显下降(P<0.05),在其余各时间点的SBP、DBP、HR、BIS值比较差异无统计学意义(P>0.05)。两组患者在拔除喉罩时间、复苏室滞留时间、离开复苏室时的VAS评分方面比较,差异无统计学意义(P>0.05)。S组患者恶心的发生率高于N组(P<0.05)。结论在喉罩置入全麻下行腹腔镜卵巢囊肿挖除术时,纳布啡与舒芬太尼均能抑制喉罩置入与拔除时的心血管反应,但纳布啡诱导过程更为平稳,术后不良反应发生率更低。

Objective：To explore the clinical effect of nalbuphine and sufentanil in laryngeal mask insertion under the general anaesthesia during laparoscopic oophorocystectomy.Methods：A total of 80 female patients,scheduled for elective laparoscopic oophorocystectomy,were randomly divided into 2 groups（n=40 each）.Nalbuphine 0.3 mg/kg（group N） or sufentanil 0.3μg/kg（group S） with midazolam 0.05 mg/kg,propofol 1.5 mg/kg and rocuronium 0.6 mg/kg were administered intravenously for laryngeal mask insertion under the general anaesthesia.The different groups of patients were observed at six times：preoperative（T0）,immediate intubation（T1）,1 min after intubation（T2）,5 min after intubation（T3）,immediate extubation（T4）,5 min after extubation（T5）,respectively and the SBP,DBP and HR were recorded.The extubation tme,rentention time,VAS score and side effects such as respiratory depressio,vertigo,nausa and vomiting were also evaluated.Results：At T1 time,SBP,DBP,HR of group S declined significantly compared with T0（P0.05） but group N had no obvious changes（P0.05）.At T2~T5 time,SBP,DBP and HR of two groups had no obviously changes（P0.05）compared with T0.At T1 time,SBP,DBP and HR of Group S declined significantly compared with Group N（P0.05） but there were no obvious changes at T2~T5 time（P0.05）.Compared with two groups,there were no obvious changes at extubation time,rentention time or VAS score（P0.05）.The incidence of nausa in Group S increased compared with group N（P0.05）.Conclusion：In laryngeal mask insertion under the general anaesthesia during laparoscopic oophorocystectomy,nalbuphine and sufentanil can depress the response of hemodynamics at intubation and extubation,but nalphine keeps more stable and the incidence of side effects is lower.