CAJ | 학술논문

目的：观察布托啡诺用于腹腔镜妇科手术全麻诱导及维持过程中拔管时对患者心血管反应等应激方面的影响，综合评价其效果。方法选取在诸暨市中心医院治疗的98例腹腔镜妇科手术患者，随机均分为对照组和实验组，每组各49例。对照组（F组）给予芬太尼作为麻醉剂，实验组（B组）给予布托啡诺作为麻醉剂，记录2组患者在进入手术室后（T0）、给予麻醉剂4 min后（T1）、插管后（T2）、手术开始后（T3）、气腹后5 min（T4），拔管前5 min（T5）以及拔管后30 min（T6）的心律情况。对所有患者进行警觉/镇静（Oberver’s assessment of alertness/sedation，OAA/S）评分。测量患者的肾上腺素、皮质醇和血糖情况。结果术前2组各指标差异无统计学意义。2组患者心率（heart rate，HR）在Tl、T2、T5均高于基础值，在T3、T4时点有所下降，T6时刻回落到基础值水平，但组间比较差异无统计学意义。B组拔管后30 min警觉/镇静（OAA/S）评分明显低于F组（P＜0．05），B组病人对麻醉满意度高。F组患者肾上腺素和皮质醇下降幅度较B组患者更明显，血糖上升幅度也明显小于B组患者，差异均有统计学意义（P＜0．05）。结论布托啡诺对患者心血管影响小，麻醉后应激反应小，持续时间长，不良反应少，相对于芬太尼具有临床优势。
목적：관찰포탁배낙용우복강경부과수술전마유도급유지과정중발관시대환자심혈관반응등응격방면적영향，종합평개기효과。방법선취재제기시중심의원치료적98례복강경부과수술환자，수궤균분위대조조화실험조，매조각49례。대조조（F조）급여분태니작위마취제，실험조（B조）급여포탁배낙작위마취제，기록2조환자재진입수술실후（T0）、급여마취제4 min후（T1）、삽관후（T2）、수술개시후（T3）、기복후5 min（T4），발관전5 min（T5）이급발관후30 min（T6）적심률정황。대소유환자진행경각/진정（Oberver’s assessment of alertness/sedation，OAA/S）평분。측량환자적신상선소、피질순화혈당정황。결과술전2조각지표차이무통계학의의。2조환자심솔（heart rate，HR）재Tl、T2、T5균고우기출치，재T3、T4시점유소하강，T6시각회락도기출치수평，단조간비교차이무통계학의의。B조발관후30 min경각/진정（OAA/S）평분명현저우F조（P＜0．05），B조병인대마취만의도고。F조환자신상선소화피질순하강폭도교B조환자경명현，혈당상승폭도야명현소우B조환자，차이균유통계학의의（P＜0．05）。결론포탁배낙대환자심혈관영향소，마취후응격반응소，지속시간장，불량반응소，상대우분태니구유림상우세。
Objective To study the comprehensive effect of butorphanol,using in laparoscopic gynecologic surgery anesthesia induction and maintenance process in tube drawing on cardiovascular response to the stress,as well as comprehensive effect.Methods There were 98 cases of patients with laparoscopic gynecologic surgery in center hospital of Zhuji city.All patients were randomly divided into group B and group F.The patients of group F were given fentanyl as an anesthetic and group B give butorphanol as narcotics.The Heart Rate(HR)was recorded,which was at the entering operation room(T0),4 min after injecting fentanyl or buotrphanol(T1),after intubation(T2),the beginning of operation(T3),5 minutes after pneumoperitoneum (T4 ),5 minutes before extubation(T5 )and half an hour after extubation(T6 ).The patients Oberver’s assessment of alertness/sedation(OAA/s)score was assessed,as well as the adrenaline,cortisol and blood sugar of all petients.Results All the operation indicators did not have significant difference in both groups before operation.HR in Tl and T2 ,T5 were higher than based values,which reduced in T3 ,T4 point,and fell the base value rate in T6 moment.But there was no significant difference between two groups.The OAA/S score in group B was lower than that of group F at 30 min after extubation(P<0.05 ).Group B patients with anesthesia satisfaction were higher.Adrenaline and cortisol of group F declined more than group B, however,the blood sugar rised less than group B.Conclusion The butorphanol has small effects on cardiovascular.The anesthesia time is longer,and has small side effects.It has clinical advantages comparing with fentanyl.