脊柱手术全麻拔管期3种不同用药方法的观察

Observations of Application of Three Different Medicine during Withdrawal in Patients with Spinal Operation

关键词:  拔管期  舒芬太尼  氟比洛芬酯  喷他佐辛

Key words:  extubation period  sufentanil  flurbiprofen  pentazocine

摘要:

目的 观察舒芬太尼、舒芬太尼复合氟比洛芬酯及喷他佐辛在脊柱手术全麻拔管期的应用。方法 选择ASAⅠ或Ⅱ级全麻下择期行脊柱手术患者60例，随机分为舒芬太尼组(S组)、舒芬太尼复合氟比洛芬酯组(SF组)、喷他佐辛组(P组)，每组20例，每组采用相同的麻醉方法。各组于手术结束前25 min分别静脉注射舒芬太尼、舒芬太尼复合氟比洛芬酯、喷他佐辛。记录患者诱导前5 min、拔管前5 min、拔管即刻、拔管后5 min、10 min平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(SpO2)及自主呼吸恢复时间、拔管时间及呼吸抑制、手术后躁动的发生率和疼痛视觉模拟评分(VAS)。结果 3组患者拔管前后心血管反应稳定、手术后躁动的发生率及拔管后VAS比较无显著性差异(P>0.05)。S组术毕清醒、拔管时间和呼吸抑制发生率与P组和SF组相比差异有统计学意义(P<0.05)。结论 3种用药方法均能有效减轻围拔管期心血管反应，缓解术后疼痛，降低全麻术后烦躁的发生率，从而提高全麻术后的苏醒质量，但舒芬太尼会延长术毕自主呼吸恢复时间及拔管时间。

Abstract:

OBJECTIVE To observe the effects of sufentanil, sufentanil combined with flurbiprofen and pentazocine during withdrawal in patients with spinal operation. METHODS Sixty patients underwent spinal operation were randomly divided into sufentanil group, sufentanil combined with flurbiprofen group and pentazocine group. There were twenty patients in each group. The same general anesthesia was done to every patient. Sufentanil, sufentanil combined with flurbiprofen and pentazocine was injected to every patient by vein before 25 minutes at the end of surgery. The mean arterial blood pressure(MAP), heart rate(HR), arterial oxygen saturation(SpO2), spontaneously breathing recovery time, extubation, respiratory depression, post-operation restlessness and VAS was recorded at specified time point. RESULTS There were no significant difference of spontaneously breathing recovery time, post-operation restlessness and VAS in the 3 groups. The recovery and extubation time was longer and the incidence rate of respiratory depression was higher in S group than P group and SF group (P<0.05). CONCLUSION Three groups of the preparation method with the medicine have more inhibitory effects on cardiovascular effects, ease the post-operation pain and reduce the incidence rate of restlessness. The sufentanil can lengthen the spontaneously breathing recovery time and extubation time.