摘要
目的探讨舒芬太尼在鼻内镜手术复合麻醉中应用的有效性和安全性。方法对200例鼻窦炎伴有鼻息肉(Ⅱ型2期)或伴鼻中隔偏曲患者行鼻内镜手术,随机分为4组:咪唑安定组(Ⅰ组),咪唑安定加芬太尼组(Ⅱ组),咪唑安定加舒芬太尼组(Ⅲ组),用药后均达OAA/S镇静评分3分;Ⅳ组为咪唑安定加舒芬太尼,用药后OAA/S镇静评分4分。记录各组用药前(T0)、局部麻醉时(T1)、开鼻窦时(T2)、鼻腔填塞时(T3)患者血压、心率、血氧饱和度的变化。记录T1、T2、T3各个时点VRS评分,比较术中各组呛咳例数、术中遗忘的例数。结果Ⅰ组T1时MAP、HR较T0显著下降。Ⅱ、Ⅲ、Ⅳ组T1、T2、T3时MAP、HR较T0均有明显下降(P<0.05)。Ⅳ组较前3组需要吸氧的例数少(P<0.05)。Ⅰ组T1和T3时口述描绘评分较其他3组高(P<0.05),而Ⅲ组和Ⅳ组T1、T3时较Ⅱ组低(P<0.05),Ⅲ组较Ⅳ组差异无显著性。Ⅰ组、Ⅱ组、Ⅲ组呛咳例数明显较Ⅳ组多(P<0.05),4组遗忘例数差异无显著性。结论舒芬太尼复合咪唑安定在鼻内镜局部手术中的应用合适的镇静深度是OAA/S镇静评分4分,此时血流动力学平稳,呼吸抑制轻,镇镇、镇痛、遗忘效果满意。
[ Objective ] To investigate the effectiveness and safety of applying sufentanil on the patients undergoing endoscopic sinus surgery with combined anesthesia. [Method ] Divide 200 patients with sinusitis accompanied by nasal polyps （type Ⅱ period 2） or nasal septum deviation who undergoing endoscopic sinus surgery into 4 groups randomly： Midazolam group （ I group）, Midazolam adding Fentanyl group （Ⅱ group）, Midazolam adding Sufentanil group （Ⅲ group）, the OAA/S sedation score of former three groups is 3 point post-administration. Midazolam adding Sufentanil group （IV group）. The OAA/S sedation score of this group is 4 point post-administration. And then at 4 points, pre-administration （To）, local anesthesia（T1）, sinus opening （T2）, nasal packing （T3）, observing the change of three vital signs, blood pressure, heart rate and blood oxygen saturation, and making out VRS score at three time points TI, T2, T3 respectively, calculating the cases of irritating cough and oblivion during operation. [ Results ] The MAP and HR at T1 in 1 group decreased somewhat as compared with those at TO. There was higher value that the MAP and HR at Tl, T2 and T3 in Ⅱ, Ⅲ and Ⅳ group has a sharp decrease as compared with those at To （P 〈0.05）. The cases of requiring oxygen inhalation in Ⅳ group is obviously less than other three groups （P 〈0.05）. The VRS score at TI, T3 in I group were significandy higher than other groups （P 〈0.05）, and VRS score at T1, T3 in Ⅲgroup and Ⅳ group are lower than those in Ⅲ group （P 〈0.05）. The difference of vital signs is not significant between Ⅲ group and IV group. The incidence of imitating cough in I, Ⅱ and Ⅲ group is more than that in ⅣV group （P 〈 0.05）. There is no statistical significance in the cases of oblivion among the 4 groups. [ Conclusions ] The appropriate OAA/S sedation score for endoscopic sinus surgery with combined anesthesia using Sufentanil is 4 point, in which patient remain stable hemodynamics, and does not significantly depress respiratory functions. The effieaey of sedation, analgesia, amnesia is all satisfied.
出处
《中国内镜杂志》
CSCD
北大核心
2010年第1期35-38,共4页
China Journal of Endoscopy
关键词
舒芬太尼
镇静
镇痛
鼻内镜手术
sufentanil
sedation
analgesia
endoscopic sinus surgery
