妇科腹腔镜手术中芬太尼应用的优化方案探讨
发布时间：2018-10-08 15:50
【摘要】：目的 观察不同剂量芬太尼复合丙泊酚在围手术期间应用的临床效果，优化妇科腹腔镜手术的麻醉方案。 方法 选择择期行腹腔镜下卵巢囊肿剥除手术患者60例，体重指数为18～25kg/m2，ASA分级I级。采用随机数字表法，，将患者分为A、B、C三组，每组20例，分别在诱导时给予芬太尼4μg/kg、6μg/kg、8μg/kg。靶控输注3.0μg/ml丙泊酚，同时分别静脉注射诱导剂量的芬太尼，待患者入睡后，静脉注射维库溴铵0.1mg/kg，3min后行气管内插管。插管后调整丙泊酚血浆靶控浓度至2.5μg/ml，术中维持此浓度不变。手术开始前追加芬太尼4μg/kg，根据手术需要间隔30min追加维库溴铵0.02～0.06mg/kg。术中MAP或HR基础值120%时给予芬太尼1μg/kg。MAP 基础值80%时给予间羟胺0.2mg。HR 50次/分，给予阿托品0.5mg。手术结束达到拔管标准后拔出气管导管。记录下面不同时间点的MAP、HR和BIS：基础值（T0）、诱导到插管前的最低值（T1）、插管后5min内的最高值（T2）、手术开始后5min内的最高值（T3）、腹腔探查后5min内的最高值（T4）、拔管后5min内的最高值（T5）。记录患者的呼之睁眼时间和拔管时间。记录手术期间丙泊酚、芬太尼和血管活性药的使用情况。记录患者拔管后5min的呼吸频率、Prince-Henry疼痛评分、Steward苏醒评分和Riker躁动评分以及纳洛酮的使用情况。术后6h随访病人有无恶心呕吐、呼吸抑制（吸空气时SpO290%）及术中知晓。 结果 （1）三组患者的MAP和HR在诱导后均低于基础值，拔管后高于基础值，但组间比较差异无统计学意义（P0.05）。插管后A组的HR明显高于基础值，C组低于基础值，差异有统计学意义（P 0.05）；B组和C组的MAP低于A组，C组低于B组，差异有统计学意义（P0.05）。手术开始后，B组和C组的MAP和HR均低于基础值和A组，C组的SBP和HR低于B组，差异有统计学意义（P 0.05）。腹腔探查后，A组和B组的MAP高于基础值，B组和C组的MAP和HR低于A组，差异有统计学意义（P 0.05）。 （2）三组患者麻醉用药后BIS均明显低于基础值（P0.05），拔管后组间比较差异无统计学意义（P0.05）。B组和C组诱导后到腹腔探查后BIS均明显低于A组，C组诱导和插管后BIS明显低于B组，差异有统计学意义（P0.05）。 （3）三组患者术中阿托品和丙泊酚使用情况无统计学意义（P0.05）。B组和C组芬太尼使用总量大于A组， C组芬太尼使用总量大于B组，差异有统计学意义（P0.05）。B组和C组术中追加芬太尼的例数明显少于A组（P 0.05）。C组使用间羟胺的例数多于A组和B组（P0.05）。 （4）三组患者术后呼之睁眼时间和拔管时间、疼痛评分、纳洛酮的使用情况及恶心呕吐的发生率比较无统计学意义（P0.05）。与A组相比，B组和C组术后躁动评分、呼吸频率降低（P 0.05）。C组的苏醒评分低于B组（P 0.05），三组患者术后随访均无术中知晓。 结论 本研究观察了在中青年妇科腹腔镜手术时，丙泊酚靶控输注复合不同剂量的芬太尼在围手期应用的临床效果。本研究分别以芬太尼4μg/kg、6μg/kg、8μg/kg复合丙泊酚3.0μg/ml诱导，手术前追加芬太尼4μg/kg，术中维持丙泊酚靶控浓度在2.5μg/ml。芬太尼4μg/kg诱导不能有效的抑制插管引起的HR和BIS升高，术中追加芬太尼的例数明显增多，术后病人容易发生躁动。芬太尼8μg/kg诱导可以有效的抑制插管反应，术中病人血压和HR较低，但麻醉期间使用间羟胺的例数增多，术后容易造成病人镇静过度。以芬太尼6μg/kg诱导，可以更好的保持血流动力学的稳定，术中追加药物少，术后苏醒质量高，是妇科腹腔镜手术的最优方案。
[Abstract]:Purpose Objective To observe the clinical effect of different doses of fentanyl and propofol in perioperative period, and to optimize the anesthesia of gynecological laparoscopic surgery. Programme Methods 60 patients with ovarian cyst undergoing laparoscopic ovarian cyst were selected. The body mass index was 18 ~ 25kg/ m2. ASA grade I. The patients were divided into three groups: A, B and C, 20 patients in each group, 4 ug/ kg fentanyl and 6 ug/ k respectively. g, 8. mu.g/ kg. Target-controlled infusion of 3. 0. m u.g/ ml of propylated phenol, at the same time, IV-induced dose of fentanyl, respectively, after the patient's sleep, intravenous vitamin B bromide 0. 1mg/ kg, 3mi n, after intubation, the plasma target control concentration of propylated hydroxyphenol is adjusted to 2.5. mu.g/ ml, In order to maintain this concentration, fentanyl 4. mu.g/ kg was added prior to the start of the operation, and the dimension library was added to 0. 02 ~ 0 according to the required interval of 30min. When MAP or HR basal value in operation was 120%, fentanyl was given 1 ug/ kg. When MAP base value was 80%, m-hydroxyamine was given to 0. 2mg. HR 50 times/ min. Atropine 0. 5mg. The end of the operation reached the pull-out standard. After calibration, pull out the endotracheal tube. Record MAP, HR, and BIS of different time points below: Base value (T0), the lowest value (T1) before intubation, the highest value (T2) within 5min after intubation, the highest value within 5min after operation (T3), and 5min after abdominal cavity exploration Maximum value (T4), within 5min after decannulation Maximum value (T5). Record the patient's wide open Eye time and decannulation time. During the operation of the procedure, propofol, fentanyl and blood vessels were recorded. Use of active drugs. Record the respiratory rate, Prince-Henry pain score, Steward wake-up score and Riker agitation score for 5min after extubation of the patient. Use of naloxone. 6-hour postoperative follow-up for patients with nausea and vomiting, respiratory depression (SpO 29 at suction) 0% Results (1) The MAP and HR of the three groups were lower than the underlying values after induction and were higher than the underlying values after extubation, but the difference between the groups was poor. In group B and group C, MAP was lower than group A and group C was lower than group B. The MAP and HR of group B and group C were lower than those in group A and group C after operation. MAP and HR of group A and group B were lower than that of group A. There was no significant difference in BIS between group B and group C (P0.05). BIS was significantly lower in group C than in group B after induction and intubation. There was no significant difference between group and group (P <0.05). (3) There was no significant difference in the use of Atropine and Propool in three groups (P0.05). The total amount of fentanyl in group C was higher than that in group A, and the difference was statistically significant (P0.05). The number of fentanyl was significantly lower than that in group A (P 0.05). The number of hydroxyamines was more than that in group A and group B (P0.05). The incidence of nausea and vomiting was not statistically significant (P0.05). and the recovery score of group C was lower than B in group C. Group (P 0.05) There was no intraoperative awareness of the follow-up of three groups of patients. Conclusion This study has observed the operation of laparoscopic surgery in young and middle-aged patients. In this study, fentanyl 4. mu.g/ kg, 6. mu.g/ kg, 8. mu.g/ kg of composite propylated hydroxyphenol 3.0. mu.g/ ml were induced, and prior to the operation. In the operation, the concentration of the target control was 2.5. m u.g/ ml. The HR and BI induced by intubation could not be effectively inhibited by fentanyl 4. m u.g/ kg. The increase of S, the number of additional fentanyl in operation increased significantly, and the patients were prone to mania after operation. Fentanyl 8 ug/ kg could effectively inhibit the intubation response, and the blood pressure and HR of patients were lower during operation. but the number of hydroxyamines used during anesthesia is increased, so that the patient is prone to sedation and excessive sedation after operation, and the fentanyl 6. m u.g/ kg can be used for better maintaining the stability of hemodynamics,
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2257344
[Abstract]:Purpose Objective To observe the clinical effect of different doses of fentanyl and propofol in perioperative period, and to optimize the anesthesia of gynecological laparoscopic surgery. Programme Methods 60 patients with ovarian cyst undergoing laparoscopic ovarian cyst were selected. The body mass index was 18 ~ 25kg/ m2. ASA grade I. The patients were divided into three groups: A, B and C, 20 patients in each group, 4 ug/ kg fentanyl and 6 ug/ k respectively. g, 8. mu.g/ kg. Target-controlled infusion of 3. 0. m u.g/ ml of propylated phenol, at the same time, IV-induced dose of fentanyl, respectively, after the patient's sleep, intravenous vitamin B bromide 0. 1mg/ kg, 3mi n, after intubation, the plasma target control concentration of propylated hydroxyphenol is adjusted to 2.5. mu.g/ ml, In order to maintain this concentration, fentanyl 4. mu.g/ kg was added prior to the start of the operation, and the dimension library was added to 0. 02 ~ 0 according to the required interval of 30min. When MAP or HR basal value in operation was 120%, fentanyl was given 1 ug/ kg. When MAP base value was 80%, m-hydroxyamine was given to 0. 2mg. HR 50 times/ min. Atropine 0. 5mg. The end of the operation reached the pull-out standard. After calibration, pull out the endotracheal tube. Record MAP, HR, and BIS of different time points below: Base value (T0), the lowest value (T1) before intubation, the highest value (T2) within 5min after intubation, the highest value within 5min after operation (T3), and 5min after abdominal cavity exploration Maximum value (T4), within 5min after decannulation Maximum value (T5). Record the patient's wide open Eye time and decannulation time. During the operation of the procedure, propofol, fentanyl and blood vessels were recorded. Use of active drugs. Record the respiratory rate, Prince-Henry pain score, Steward wake-up score and Riker agitation score for 5min after extubation of the patient. Use of naloxone. 6-hour postoperative follow-up for patients with nausea and vomiting, respiratory depression (SpO 29 at suction) 0% Results (1) The MAP and HR of the three groups were lower than the underlying values after induction and were higher than the underlying values after extubation, but the difference between the groups was poor. In group B and group C, MAP was lower than group A and group C was lower than group B. The MAP and HR of group B and group C were lower than those in group A and group C after operation. MAP and HR of group A and group B were lower than that of group A. There was no significant difference in BIS between group B and group C (P0.05). BIS was significantly lower in group C than in group B after induction and intubation. There was no significant difference between group and group (P <0.05). (3) There was no significant difference in the use of Atropine and Propool in three groups (P0.05). The total amount of fentanyl in group C was higher than that in group A, and the difference was statistically significant (P0.05). The number of fentanyl was significantly lower than that in group A (P 0.05). The number of hydroxyamines was more than that in group A and group B (P0.05). The incidence of nausea and vomiting was not statistically significant (P0.05). and the recovery score of group C was lower than B in group C. Group (P 0.05) There was no intraoperative awareness of the follow-up of three groups of patients. Conclusion This study has observed the operation of laparoscopic surgery in young and middle-aged patients. In this study, fentanyl 4. mu.g/ kg, 6. mu.g/ kg, 8. mu.g/ kg of composite propylated hydroxyphenol 3.0. mu.g/ ml were induced, and prior to the operation. In the operation, the concentration of the target control was 2.5. m u.g/ ml. The HR and BI induced by intubation could not be effectively inhibited by fentanyl 4. m u.g/ kg. The increase of S, the number of additional fentanyl in operation increased significantly, and the patients were prone to mania after operation. Fentanyl 8 ug/ kg could effectively inhibit the intubation response, and the blood pressure and HR of patients were lower during operation. but the number of hydroxyamines used during anesthesia is increased, so that the patient is prone to sedation and excessive sedation after operation, and the fentanyl 6. m u.g/ kg can be used for better maintaining the stability of hemodynamics,
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【共引文献】
相关硕士学位论文 前1条
1 张霞;芬太尼在腹腔镜胆囊切除术中优化应用的探讨[D];苏州大学;2014年
本文编号：2257344
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