不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响

发布时间：2018-05-19 22:38

本文选题：纳布啡 + 丙泊酚　；参考：《中国药房》2017年35期

【摘要】：目的:探讨不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响。方法:选取2016年2-11月拟行无痛宫腔镜手术的住院患者120例作为研究对象,采用随机数字表法分为P、N1、N2、N3组,各30例。4组患者均进行常规的术前准备,N1、N2和N3组患者分别于1～2 min内缓慢给予盐酸纳布啡注射液0.05、0.10、0.15 mg/kg,iv;注射3 min后,4组患者均给予2%盐酸利多卡因注射液2 m L,iv+丙泊酚注射液1 mg/kg,iv(40 mg/10 s),再缓慢推注(10 mg/10 s)丙泊酚注射液至患者睫毛反射消失、呼之无应答;术中丙泊酚注射液均以6 mg/(kg·h)的速度经微泵输注维持麻醉至手术结束。观察入室时(T_0)、丙泊酚推注前(T_1)、丙泊酚推注完毕即刻(T_2)、扩宫颈时(T_3)、手术结束时(T_4)和麻醉苏醒时(T_5)4组患者的血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)]和血氧饱和度(Sp O_2)水平,以及丙泊酚诱导剂量、维持剂量、总剂量、总给药时间、单位时间剂量和患者麻醉苏醒时间和麻醉苏醒时数字疼痛分级法(NRS)评分,并记录术中及麻醉恢复期的不良反应发生情况。结果:4组患者丙泊酚维持剂量、总给药时间及体动反应、低血压、窦性心动过缓和恶心呕吐的发生率比较,差异均无统计学意义(P0.05)。T_0时,4组患者血流动力学参数及Sp O_2比较,差异均无统计学差异(P0.05)。与T_0时比较,4组患者SBP在T_2时显著降低,N1组在T_3、T_4时显著降低,N2组在T_3时显著降低,差异均有统计学意义(P0.05);4组患者DBP在T_2时显著降低,N1组在T_3～T_5时显著降低,N2组在T_3时显著降低,差异均有统计学意义(P0.05);P组患者在T_3时HR显著降低,N3组在T_5时显著降低,差异均有统计学意义(P0.05);4组患者Sp O_2在T_2时显著降低,N3组在T_3时显著降低,差异均有统计学意义(P0.05);N3组患者T_1时Sp O_2显著低于P组,在T_2时显著低于其余各组,在T_3时显著低于P组和N1组,差异均有统计学意义(P0.05)。与P组比较,N2、N3组患者丙泊酚诱导剂量、总剂量、单位时间剂量及NRS评分均显著降低;N1、N2和N3组麻醉苏醒时间均显著缩短,差异均有统计学意义(P0.05)。与N1组比较,N2、N3组丙泊酚诱导剂量、总剂量、单位时间剂量和NRS评分均显著降低,麻醉苏醒时间显著缩短,差异均有统计学意义(P0.05)。与N2组比较,N3组丙泊酚诱导剂量、总剂量均显著降低,差异均有统计学意义(P0.05)。与P组比较,N3组患者头晕发生率显著增加;与P、N1和N2组比较,N3组患者低氧血症发生率显著增加,差异均有统计学意义(P0.05)。结论:0.10 mg/kg的纳布啡联合丙泊酚用于宫腔镜手术既能达到良好的麻醉和镇痛效果,又具有较高的安全性。
[Abstract]:Objective: to investigate the effect of different doses of nalbukephalin combined with propofol on anesthesia and analgesia in patients undergoing hysteroscopic surgery. Methods: 120 inpatients undergoing painless hysteroscopic surgery from February to November 2016 were selected as study subjects. 30 patients in each group were given routine preoperative preparation: naborphine hydrochloride (0.05g / kg / kg) and lidocaine hydrochloride (2 mL / iv) were given 2% lidocaine hydrochloride (Lidocaine) injection 2 mL / kg / kg iv for 1 min / 2 min, respectively, and 2% lidocaine hydrochloride injection (2 mL / iv) was given to all patients in each group (n = 30) for 3 min after intravenous injection of naborphine hydrochloride (0.05g / kg / kg). Propofol injection (1 mg / kg iv 40 mg/10 s-1) propofol injection (10 mg/10 s) was given to the patients until the eyelash reflex disappeared. During the operation, propofol injection was maintained at the rate of 6 mg/(kg / h by micropump infusion until the end of the operation. The hemodynamic indexes (SBP, DBP, HRH) and blood oxygen saturation were observed in T _ 0, T _ 1, T _ (2), T _ (3), T _ (3) and T _ (4) at the end of cervix expansion and in T _ 5 / T _ (5) at anaesthesia, respectively, and in the blood oxygen saturation (SBP, DBP, HRV) and blood oxygen saturation (SPO _ (2) in all the patients in the group T _ 0, T _ 1, T _ (1), T _ (1), T _ (1), T _ (2), T _ (3) and T _ (5) at the end of operation. The induction dose of propofol, the maintenance dose, the total administration time, the unit time dose and the anaesthesia recovery time and the NRSs score during anaesthesia recovery were also evaluated. Adverse reactions during operation and recovery of anesthesia were recorded. Results there was no significant difference in hemodynamic parameters and spp O _ 2 between the four groups of patients with propofol maintenance dose, total administration time, body motility reaction, hypotension, sinus palliative nausea and vomiting. The difference was not statistically significant (P 0.05). Compared with T0, the SBP of the four groups was significantly lower than that of the control group at T2 and the N1 group was significantly lower than that of the N _ 1 group at the time of T _ 3 / T _ 4. The DBP of the N _ 1 group was significantly lower than that of the N _ 1 group at T3 / T _ 3, and the DBP of the N _ 1 group was significantly lower than that of the N _ 1 group at T2 / T _ 3, and the N _ 2 group was significantly lower than that of the N _ 1 group at T _ 3 / T _ 3. The difference was statistically significant (P 0.05). The HR of group N3 was significantly lower than that of group N3. The difference was statistically significant (P 0.05). The difference of SP O _ 2 in group P _ (0.05) was significantly lower than that in group N _ (3) at T _ (2), and that in group N _ (3) was significantly lower at T _ (3) than that in group N _ (3) at T _ (3). The difference was statistically significant (P < 0.05). The Sp / O _ 2 was significantly lower in group T _ 1 than that in group P, and lower than that in other groups at T _ (2), P _ (0.05) at T _ (3) and N _ (1). The difference was statistically significant (P < 0.05). Compared with group P, the induction dose, total dose, unit time dose and NRS score of propofol in group N _ 2 and N _ 3 were significantly reduced, and the recovery time of anesthesia in group N _ 1, N _ 2 and N _ 3 were significantly shorter than those in group N _ 2 and N _ 3 (P < 0.05). Compared with N1 group, propofol induction dose, total dose, unit time dose and NRS score of N _ 2N _ 3 group were significantly decreased, and the anaesthesia recovery time was significantly shortened (P < 0.05). The induced dose of propofol and the total dose of propofol in group N _ 3 were significantly lower than those in group N _ 2, and the difference was statistically significant (P 0.05). Compared with group P, the incidence of dizziness in group N 3 was significantly higher than that in group P, and the incidence of hypoxemia in group N 3 was significantly higher than that in group N 1 and group N 2 (P 0.05). Conclusion the combination of naporphine and propofol at 0. 10 mg/kg for hysteroscopic surgery can not only achieve good anaesthesia and analgesia effect, but also have high safety.
【作者单位】：辽宁中医药大学附属医院麻醉科;
【分类号】：R614

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