【摘要】 目的探讨持续泵注舒芬太尼在老年妇科患者开腹手术中的安全性和有效性。方法 80例ASAⅡ-Ⅲ级择期行妇科开腹手术患者,年龄60~85岁,随机分为两组:R组40例采用瑞芬太尼6μg/kg·h;S组40例采用舒芬太尼0.1μg/kg·h。于麻醉诱导气管插管后吸入1~3%七氟烷维持麻醉,根据患者入组情况分别持续泵注瑞芬太尼和舒芬太尼,于手术结束前10分钟停止泵注镇痛药。记录患者的一般情况、生命体征变化情况,麻黄碱、阿托品的用量,记录患者术后呼吸和意识恢复情况、苏醒后的疼痛评分及患者苏醒即刻躁动的发生率。结果低血压和心率减慢的发生率在S组为37.5%和20%均低于R组的60.5%和62.5%,差异有统计学意义(P<0.05);相应麻黄碱和阿托品的用量S组为(5.48±2.27)和(0.33±0.12)也明显低于R组的(12.4±3.23)和(0.81±0.13),差异有统计学意义(P<0.05);呼吸恢复时间和潮气量恢复时间R组为(4.3±2.2)min和(5.6±1.5)min均短于S组的(6.3±3.4)min和(8.1±2.5)min,差异有统计学意义(P<0.05);但两组意识恢复时间差异无统计学意义(P>0.05);疼痛评分R组明显高于S组,分别为(6.5±2.6)分和(4.1±1.3)分(P<0.05);苏醒即刻躁动发生率S组明显低于R组,分别为12.5%和55%,差异有统计学意义(P<0.05)。结论舒芬太尼持续泵注具有血流动力学稳定、术后恢复快、不良反应少、镇痛作用较强等优点,可安全用于老年患者妇科开腹手术的麻醉维持。更多还原

【Abstract】 Objective To study the safety and efficacy of the continuous sufentanil infusion in elderly patients with gynecological surgery.Methods 80 60-85 years old elderly patients,ASA Ⅱ-Ⅲ,undergoing elective gynecological surgery,were randomly divided into group R(remifentanyl 6μg/kg/h)and group S(sufentanil 0.1μg/kg/h),40 cases in each group.After tracheal intubation,the patients maintained anesthesia with 1-3%sevoflurane,continuously infusion of sufentanil or remifentanyl respectively.10 minutes before the end of surgery,analgesics were stopped.The general condition,the vital signs,the dosage of ephedrine and atropine,the time to breathing recovery,the time to consciousness recovery,postoperative pain scores and the incidence of agitation at the moment of awareness recovery were recorded.Results,The incidence of hypotension and bradycardia in the group S was lower than that in the group R(37.5% vs60.5%,20% vs 62.5%,respectively,P<0.05).The dosage of ephedrine and atropine n the group S was also lower than that in the group R(5.48±2.27 vs12.4±3.23,0.33±0.12 vs 0.81 0.13,respectively,P<0.05).The time to breathing recovery and tidal volume recovery of the group R was shorter than that in the group S(4.3±2.2)min vs(6.3±3.4)min,(5.6±1.5)min vs(8.1±2.5)min,respectively,P<0.05).But the time to consciousness recovery was no statistical difference between two groups.Postoperative pain scores of the group R were obviously higher than that of the group S(6.5±2.6v.s.4.1±1.3,P<0.05).The incidence of agitation in the group S was lower than that in the groupR(12.5% v.s.55%,P<0.05).Conclusion Continuously infusing sufentanil can be safely used in elderly patients undergoing gynecological surgery.The advantages of it included remaining hemodynamic stability,improving postoprative recovery and analgesia,lessening adverse reactions.更多还原