【作者】 王玥；

【导师】 赵国庆；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2018， 硕士

【摘要】 目的:探讨酒石酸布托啡诺注射液与枸橼酸舒芬太尼注射液复合丙泊酚用于经尿道膀胱肿瘤电切术(TURBt)麻醉对患者的影响。方法:选取我院择期拟在静脉麻醉下行经尿道膀胱肿瘤电切术患者60例,年龄35~65岁,ASA分级I级~II级,按随机数字表法将患者分为接受布托啡诺诱导B组和舒芬太尼组S组。所有病患手术前禁食6小时,禁饮4小时,没有任何手术前用药,进入手术间后,立即开放上肢静脉通路,常规持续监测心电图(ECG)、血氧饱和度(Sp O2)、无创动脉血压(NBP)、脑电双频谱指数(BIS)并记录,给予面罩吸氧3~4L/min。麻醉诱导:S组静推舒芬太尼0.075μg/kg,3min后按丙泊酚2 mg/kg缓慢推注;B组静推布托啡诺15μg/kg,3min后按丙泊酚2 mg/kg缓慢推注。边推注边观察患者的意识,待患者意识消失且BIS为55±5时置入喉罩后进行手术操作,术中用4~7mg?Kg-1?h-1丙泊酚泵注维持麻醉。当完成TURBt操作时,停止输注丙泊酚,等待患者苏醒,直至患者对指令做出正确反应后,拔出喉罩,送往麻醉苏醒室观察一段时间,继续给予面罩吸氧3~4L/min和静脉输液,Steward苏醒评分达4分以上可送回病房。观察并记录患者麻醉前(T0)、手术开始时(T1)、手术后10 min(T2)以及苏醒时(T3)的NBP、HR、Sp O 2及BIS的变化,同时记录苏醒时间。随访并记录术后VAS、Ramsay以及BCS评分,并观察是否有呼吸抑制、苏醒期躁动、恶心、呕吐、头晕、头痛等等不良反应。结果:两组患者在T0时的SBP、DBP、HR无统计学意义(P>0.05);与S组比较,T1、T2时B组的BIS值下降明显(P<0.05)。组内比较:两组患者的SBP、DBP、HR、BIS值,在T1、T2时间段较T0时间段下降显著(P<0.05)。两组患者的苏醒时间无明显差异(P>0.05)。B组患者各时间点的Sp O2无明显差异(P>0.05),S组中有11位患者在T1时刻与T0时刻相比,出现Sp O2明显下降(P=0.007),T2、T3无明显变化;两组患者术后VAS视觉评分、舒适度(BCS)评分无明显差异(P>0.05),Ramsay镇静评分B组比S组高(P<0.05)。B组患者的术后恶心、呕吐的发生率明显低于S组(P<0.05)。结论:使用布托啡诺15μg/kg静脉麻醉诱导下行经尿道膀胱肿瘤电切术,可以很好地控制术中的疼痛,镇静效果好,并且术中血流动力学稳定,术后恶心、呕吐等不良反应少。临床上仍需要进一步讨论布托啡诺用于小型手术的最佳剂量以及布托啡诺和舒芬太尼的精确等价剂量。更多还原

【Abstract】 Objective:To study the effect of butorphanol and sufentanil combined with propofol for the anesthesia of transurethral resection of bladder tumor(TURBt)on patients.Methods:60 cases of patients underwent transurethral resection of bladder tumor under intravenous anesthesia with selective time of our hospital was selected,aged 35 to 65 years,and ASA grade : I ~ II grade,the patients were divided into butorphanol(B group)and sufentanil(S group)by random number table method.All patients were fasted for 6hours before operation,no drink for 4 hours,without pre-operative medication.And after entering the operation room,open the upper limb venous access immediately,the routine continuous electrocardiogram(ECG),blood oxygen saturation(Sp O2),noninvasive arterial blood pressure(NBP)and bispectral index(BIS)were recorded,and the oxygen inhalation 3 ~ 4L/min was given.Anesthesia induction: group S was given with 0.075 μg/kg sufentanil,and 3minutes later the subject was injected slowly with 2 mg / kg propofol;group B was given with 15μg/kg butorphanol,and 3 minutes later the subject was injected slowlywith 2 mg / kg propofol.The consciousness of the patient was observed while intravenous injection was performed.When the patient’s consciousness disappeared and the BIS was 55 ± 5,the surgery was performed after that the laryngeal mask was implanted.During the operation,4~7mg·kg-1·h-1propofol pump was used to maintain anesthesia.When the TURBt operation was completed,the infusion of propofol was stopped,waited for the patient to wake up,until that the patient responded correctly to the instruction,the laryngeal mask was pulled out.The patient was sent to the anaesthesia recovery room for observation for a period of time,it was continue to give oxygen inhalation 3 ~ 4L / min and intravenous infusion,the patient with Steward awaken score,which was up to 4 points or more could be sent back to the ward.The patients were observed and recorded changes in NBP,HR,Sp O2 and BIS before anesthesia(T 0),beginning operation(T1),10 min after operation(T2)and waking up(T3),and the waking time was recorded.Followed up and recorded the VAS,Ramsay,and BCS scores after the operation,and observed whether there were respiratory depression and adverse reactions,such as restlessness,nausea,vomiting,dizziness,headache,and so on in the awakening period.Results:There was no significant difference in SBP,DBP and HR between the two groups at T0(P > 0.05);compared with group S,the BIS value ofgroup B at T1 and T2 decreased significantly(P < 0.05).Intra group comparison: the SBP,DBP,HR,BIS values of the two groups decreased significantly in T1、T2,compared with T0(P < 0.05).There was no significant difference in waking time between the two groups(P > 0.05).There was no significant difference in Sp O2 at each time point in group B patients(P > 0.05),and 11 patients in group S,the value at T0 time were compared with at T1 time,there was a significant decrease in Sp O2(P = 0.07),and there was no significant change in T2 and T3.There was no difference in VAS visual score and comfort score(BCS)between the two groups of patients after operation(P > 0.05),and the Ramsay sedation score was higher in group B than in group S(P < 0.05).The incidence of postoperative nausea and vomiting in group B was significantly lower than that of group S(P< 0.05).Conclusion :Transurethral resection of bladder tumor induced by intravenous anesthesia with 15 μg/kg butorphanol,it could well control the pain during operation,the sedative effect was good,and the hemodynamics was stable during the operation.And the adverse reactions such as postoperative nausea and vomiting and so on were less.It still needed to be further discussed in clinical that the optimal dose of butorphanol in small surgery and the exact equivalent dose of butorphanol and sulfentanil.更多还原