CAJ | 학술논문

目的研究舒芬太尼对全麻老年患者苏醒期镇痛效果及血流动力学的影响.方法将80例全麻手术患者随机分为4组,每组20例.各组患者分别于缝皮前10 min静脉给予生理盐水5ml(对照组,C组)、舒芬太尼0.2 μg/kg(S1组)、0.4μg/kg(S2组)和0.6μg/kg(S3组).记录患者自主呼吸恢复时间、呼唤睁眼和拔管时间,苏醒期呛咳、恶心、呕吐发生例数及拔管后10 min VRS疼痛评分和Ramsay清醒评分情况.观察并记录麻醉诱导前(T0)、停全麻药后(T1)、拔管前(T2)、拔管后即刻(T3)、拔管后5 min(T4)和拔管后10 min(TS)不同时间点平均动脉压(MAP)和心率(HR).结果 S1组、S2组与C组比较患者自主呼吸恢复时间、呼唤睁眼时间、拔管时间和出手术室时间差异均无统计学意义(P均＞0.05),S3组拔管时间明显延长(P＜0.01)；S3组与C组比较患者自主呼吸恢复时间[(7.3 ±4.1)min与(10.2 ±4.7) min]、呼唤睁眼时间[(8.1±3.1)min与(11.2±3.7) min]、拔管时间[(12.3±3.1)min与(16.3±5.9)min]和出手术室时间[(21.4 ±3.0)min与(24.2±3.5)min]差异均有统计学意义(P＜0.01或P＜0.05)；S1组、S2组和S3组与C组比较发生呛咳例数明显减少(P均＜0.05),恶心呕吐发生例数差异无统计学意义(P均＞0.05).VRS疼痛评分和Ramsay清醒评分S1-3组与C组比较差异均有统计学意义(P均＜0.01)；与T0比较,各组患者术毕各时点MAP和HR显著增高(P ＜0.01或P＜0.05)；S1-3组MAP和HR与C组比较差异均有统计学意义(P＜0.05或P＜0.01).结论全麻结束前静脉注射舒芬太尼0.2～0.4 μg/kg能提高患者镇痛效果,稳定血流动力学,对苏醒质量无明显影响.
목적 연구서분태니대전마노년환자소성기진통효과급혈류동역학적영향.방법 장80례전마수술환자수궤분위4조,매조20례.각조환자분별우봉피전10 min정맥급여생리염수5ml(대조조,C조)、서분태니0.2 μg/kg(S1조)、0.4μg/kg(S2조)화0.6μg/kg(S3조).기록환자자주호흡회복시간、호환정안화발관시간,소성기창해、악심、구토발생례수급발관후10 min VRS동통평분화Ramsay청성평분정황.관찰병기록마취유도전(T0)、정전마약후(T1)、발관전(T2)、발관후즉각(T3)、발관후5 min(T4)화발관후10 min(TS)불동시간점평균동맥압(MAP)화심솔(HR).결과 S1조、S2조여C조비교환자자주호흡회복시간、호환정안시간、발관시간화출수술실시간차이균무통계학의의(P균＞0.05),S3조발관시간명현연장(P＜0.01)；S3조여C조비교환자자주호흡회복시간[(7.3 ±4.1)min여(10.2 ±4.7) min]、호환정안시간[(8.1±3.1)min여(11.2±3.7) min]、발관시간[(12.3±3.1)min여(16.3±5.9)min]화출수술실시간[(21.4 ±3.0)min여(24.2±3.5)min]차이균유통계학의의(P＜0.01혹P＜0.05)；S1조、S2조화S3조여C조비교발생창해례수명현감소(P균＜0.05),악심구토발생례수차이무통계학의의(P균＞0.05).VRS동통평분화Ramsay청성평분S1-3조여C조비교차이균유통계학의의(P균＜0.01)；여T0비교,각조환자술필각시점MAP화HR현저증고(P ＜0.01혹P＜0.05)；S1-3조MAP화HR여C조비교차이균유통계학의의(P＜0.05혹P＜0.01).결론 전마결속전정맥주사서분태니0.2～0.4 μg/kg능제고환자진통효과,은정혈류동역학,대소성질량무명현영향.
Objective To study the influence of sufentanil on analgesic effect and hemodynamics during recovery period of general anesthesia in elderly patients.Methods Eighty patients with general anesthesia were randomly divided into 4 groups (20 cases in each group).Ten min before surgery ended patients in each group were intravenous injected different dose of sufentanil:group S1 with sufentanil 0.2 μg/kg,group S2 0.4 μg/kg,group S3 0.6 μg/kg,and group C (control group) with saline 5 ml.The time of spontaneous breath restores,the time of summon opening eyes and extubation,the cases occurred cough,nausea,vomiting during recovery period were recorded and the VRS pain scores and Ramsay score 10 min after extubation were also recorded.Mean arterial pressure (MAP) and the heart rate (HR) were recorded before the anesthesia induction(T0),stopped anesthetic (T1),pre-extubation (T2),5 min and 10 min after extubation (T3 or T4)Results As group S1 and S2 compared with group C,there was no significant difference on the time of spontaneous breath restores,the time of summon opening eyes,and the time of extubation and leaving the operating room (P ＞ 0.05).However,there was significant difference on the time of spontaneous breath restores ((7.3 ± 4.1) min vs (10.2 ± 4.7) min),the time of summon opening eyes ((8.1 ± 3.1) min vs (11.2 ± 3.7)min),the time of extubation ((12.3 ± 3.1) min vs (16.3 ± 5.9) min),and the time of leaving the operating room((21.4 ±3.0)min vs (24.2 ±3.5)min) between the group S3 and group C(P＜0.01 or P ＜0.05)Patients occurred cough in group S1,S2 and S3 were less than those in group C (P ＜0.05),but there was no significant difference on the occurrence of nausea and vomiting between group S1-3 and group C (P ＞ 0.05)There was significant difference on VRS pain score and Ramsav score between group S1-3 and group C(P ＜0.01).MAP and HR were increased in all points of time as compared with T0 (P ＜ 0.05 or P ＜ 0.01).And there was significant difference on MAP and HR between group S1-3 and group C (P ＜ 0.05 or P ＜ 0.01).Conclusion Before the end of anesthesia sufentanil 0.2 ～ 0.4 μg/kg intravenous injection could be able to enhance analgesic effect,stabilize hemodynamics and do not affect regain consciousness in elderly patients.