不同剂量舒芬太尼全麻诱导喉罩插管对血流动力学的影响

发布时间：2018-07-11 17:34

  本文选题：舒芬太尼 + 喉罩　； 参考：《山东大学》2015年硕士论文

【摘要】：[目的]舒芬太尼是一种强效的阿片类麻醉镇痛药,为特异性的μ1受体高选择性的激动剂,具有给药方便,起效快,对心血管和呼吸系统影响较小,无组胺释放等特点,而广泛应用于临床麻醉。喉罩是介于面罩和气管插管之间维持气道通气的一种新型通气工具,它既可选择性的用于麻醉也可用于急症困难气道,操作方便简单。全麻诱导期间喉罩插管时,对咽喉部刺激比较轻,同时对血流动力学和应激反应的影响也较小。以往的研究大多都是通过镇静药、麻醉性镇痛药、肌肉松弛药三者组合来研究喉罩插管对血流的影响,由于有肌肉松弛剂的作用,研究结果往往特异性差。本研究以BIS指数作为麻醉深度标准,研究应用丙泊酚维持在同一麻醉深度下,评价3种不同剂量的舒芬太尼在麻醉诱导喉罩插管期间对血流动力学的作用比较,为临床用药提供更加合适剂量。[方法]采用随机、对照和双盲的研究方法。选择普外科择期手术120例,经过充分术前准备,选择ASA分级为Ⅰ至II级的患者,随机数字法分为四组,每组为30例。舒芬太尼组：Ⅰ组(D1组)、Ⅱ组(D2组)及Ⅲ组(D3组)分别给予舒芬太尼0.3、0.4及0.5μg·kg-1。对照组(C组)为4 μg· kg-1芬太尼注射液,四组药物分别在麻醉诱导时通过静脉缓慢注入,时间约30秒。4组患者的麻醉诱导、维持过程相同。在注入舒芬太尼或芬太尼之前,四组患者分别靶控注入丙泊酚,并调节用药量,使BIS数值控制在50±5范围之内。监测并记录各组患者用药前(TO)、诱导时(T1)、麻醉诱导后2min(T2)、插管即时(T3)、插管后1min(T4)、3min(T5)、5min(T6)、10min(T7),各节点的血流动力学参数的测得值、BIS值、丙泊酚的用量。[结果]四组患者的一般情况,如性别、年龄、体重、基础血压、心电图、身高等比较,差异均无统计学意义(P0.05),而四组所使用的丙泊酚总量也无明显的差异性(P0.05)。D1组、D2组及D3组丙泊酚的用量分别为(5.0±1.5)、(5.0±1.1)和(5.1±0.5)mg·kg-1·h-1,C组为(5.0±1.0)mg·kg-1·h-1。在麻醉诱导时D1、D2和D3组与C组相比,D1、D2、D3组患者的血流动力学参数波动较较C组小,C组患者的血流动力学波动比较大。D1、D2、和D3组相比较,D2组血流动力学更为稳定。患者在四组中均未见严重不良反应。[结论]舒芬太尼比芬太尼在麻醉诱导期喉罩插管中有更好的血流动力学稳定性,随着使用剂量的逐渐增加,可相应地减少麻醉诱导期丙泊酚的使用总量。靶控输注丙泊酚使诱导期BIS值在(50±5),复合0.4 μg·kg-1舒芬太尼,能更好的维持血流动力学的稳定。
[Abstract]:[objective] Sufentanil is a powerful opioid analgesics and analgesics. It is a highly selective agonist of specific 渭 1 receptor. It has the advantages of convenient administration, rapid onset, little effect on cardiovascular and respiratory system, and no histamine release. And widely used in clinical anesthesia. Laryngeal mask is a new type of ventilation tool between mask and tracheal intubation. It can be used in anesthesia and emergency airway easily and easily. During laryngeal mask intubation during general anesthesia induction, the stimulation of pharynx and larynx was relatively light, and the effect on hemodynamics and stress response was also small. Most of the previous studies have studied the effects of laryngeal mask intubation on blood flow through the combination of sedatives, anaesthetic analgesics and muscle relaxants. Because of the effect of muscle relaxants, the results are often not specific. In this study, the BIS index was used as the standard of anesthetic depth to evaluate the hemodynamic effects of three different doses of sufentanil during the induction of laryngeal mask intubation by using propofol to maintain the same anesthetic depth. To provide a more appropriate dose for clinical use. [methods] A randomized, controlled and double blind study was used. 120 patients with elective surgery in general surgery were selected, and 30 patients with ASA grade 鈪，

本文编号：2116046