本文選題：納布啡 + 丙泊酚　； 參考：《中國(guó)藥房》2017年35期

【摘要】：目的:探討不同劑量納布啡聯(lián)合丙泊酚對(duì)宮腔鏡手術(shù)患者麻醉和鎮(zhèn)痛效果的影響。方法:選取2016年2-11月擬行無痛宮腔鏡手術(shù)的住院患者120例作為研究對(duì)象,采用隨機(jī)數(shù)字表法分為P、N1、N2、N3組,各30例。4組患者均進(jìn)行常規(guī)的術(shù)前準(zhǔn)備,N1、N2和N3組患者分別于1～2 min內(nèi)緩慢給予鹽酸納布啡注射液0.05、0.10、0.15 mg/kg,iv;注射3 min后,4組患者均給予2%鹽酸利多卡因注射液2 m L,iv+丙泊酚注射液1 mg/kg,iv(40 mg/10 s),再緩慢推注(10 mg/10 s)丙泊酚注射液至患者睫毛反射消失、呼之無應(yīng)答;術(shù)中丙泊酚注射液均以6 mg/(kg·h)的速度經(jīng)微泵輸注維持麻醉至手術(shù)結(jié)束。觀察入室時(shí)(T_0)、丙泊酚推注前(T_1)、丙泊酚推注完畢即刻(T_2)、擴(kuò)宮頸時(shí)(T_3)、手術(shù)結(jié)束時(shí)(T_4)和麻醉蘇醒時(shí)(T_5)4組患者的血流動(dòng)力學(xué)指標(biāo)[收縮壓(SBP)、舒張壓(DBP)、心率(HR)]和血氧飽和度(Sp O_2)水平,以及丙泊酚誘導(dǎo)劑量、維持劑量、總劑量、總給藥時(shí)間、單位時(shí)間劑量和患者麻醉蘇醒時(shí)間和麻醉蘇醒時(shí)數(shù)字疼痛分級(jí)法(NRS)評(píng)分,并記錄術(shù)中及麻醉恢復(fù)期的不良反應(yīng)發(fā)生情況。結(jié)果:4組患者丙泊酚維持劑量、總給藥時(shí)間及體動(dòng)反應(yīng)、低血壓、竇性心動(dòng)過緩和惡心嘔吐的發(fā)生率比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。T_0時(shí),4組患者血流動(dòng)力學(xué)參數(shù)及Sp O_2比較,差異均無統(tǒng)計(jì)學(xué)差異(P0.05)。與T_0時(shí)比較,4組患者SBP在T_2時(shí)顯著降低,N1組在T_3、T_4時(shí)顯著降低,N2組在T_3時(shí)顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);4組患者DBP在T_2時(shí)顯著降低,N1組在T_3～T_5時(shí)顯著降低,N2組在T_3時(shí)顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);P組患者在T_3時(shí)HR顯著降低,N3組在T_5時(shí)顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);4組患者Sp O_2在T_2時(shí)顯著降低,N3組在T_3時(shí)顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);N3組患者T_1時(shí)Sp O_2顯著低于P組,在T_2時(shí)顯著低于其余各組,在T_3時(shí)顯著低于P組和N1組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。與P組比較,N2、N3組患者丙泊酚誘導(dǎo)劑量、總劑量、單位時(shí)間劑量及NRS評(píng)分均顯著降低;N1、N2和N3組麻醉蘇醒時(shí)間均顯著縮短,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。與N1組比較,N2、N3組丙泊酚誘導(dǎo)劑量、總劑量、單位時(shí)間劑量和NRS評(píng)分均顯著降低,麻醉蘇醒時(shí)間顯著縮短,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。與N2組比較,N3組丙泊酚誘導(dǎo)劑量、總劑量均顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。與P組比較,N3組患者頭暈發(fā)生率顯著增加;與P、N1和N2組比較,N3組患者低氧血癥發(fā)生率顯著增加,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:0.10 mg/kg的納布啡聯(lián)合丙泊酚用于宮腔鏡手術(shù)既能達(dá)到良好的麻醉和鎮(zhèn)痛效果,又具有較高的安全性。
[Abstract]:Objective: to investigate the effect of different doses of nalbukephalin combined with propofol on anesthesia and analgesia in patients undergoing hysteroscopic surgery. Methods: 120 inpatients undergoing painless hysteroscopic surgery from February to November 2016 were selected as study subjects. 30 patients in each group were given routine preoperative preparation: naborphine hydrochloride (0.05g / kg / kg) and lidocaine hydrochloride (2 mL / iv) were given 2% lidocaine hydrochloride (Lidocaine) injection 2 mL / kg / kg iv for 1 min / 2 min, respectively, and 2% lidocaine hydrochloride injection (2 mL / iv) was given to all patients in each group (n = 30) for 3 min after intravenous injection of naborphine hydrochloride (0.05g / kg / kg). Propofol injection (1 mg / kg iv 40 mg/10 s-1) propofol injection (10 mg/10 s) was given to the patients until the eyelash reflex disappeared. During the operation, propofol injection was maintained at the rate of 6 mg/(kg / h by micropump infusion until the end of the operation. The hemodynamic indexes (SBP, DBP, HRH) and blood oxygen saturation were observed in T _ 0, T _ 1, T _ (2), T _ (3), T _ (3) and T _ (4) at the end of cervix expansion and in T _ 5 / T _ (5) at anaesthesia, respectively, and in the blood oxygen saturation (SBP, DBP, HRV) and blood oxygen saturation (SPO _ (2) in all the patients in the group T _ 0, T _ 1, T _ (1), T _ (1), T _ (1), T _ (2), T _ (3) and T _ (5) at the end of operation. The induction dose of propofol, the maintenance dose, the total administration time, the unit time dose and the anaesthesia recovery time and the NRSs score during anaesthesia recovery were also evaluated. Adverse reactions during operation and recovery of anesthesia were recorded. Results there was no significant difference in hemodynamic parameters and spp O _ 2 between the four groups of patients with propofol maintenance dose, total administration time, body motility reaction, hypotension, sinus palliative nausea and vomiting. The difference was not statistically significant (P 0.05). Compared with T0, the SBP of the four groups was significantly lower than that of the control group at T2 and the N1 group was significantly lower than that of the N _ 1 group at the time of T _ 3 / T _ 4. The DBP of the N _ 1 group was significantly lower than that of the N _ 1 group at T3 / T _ 3, and the DBP of the N _ 1 group was significantly lower than that of the N _ 1 group at T2 / T _ 3, and the N _ 2 group was significantly lower than that of the N _ 1 group at T _ 3 / T _ 3. The difference was statistically significant (P 0.05). The HR of group N3 was significantly lower than that of group N3. The difference was statistically significant (P 0.05). The difference of SP O _ 2 in group P _ (0.05) was significantly lower than that in group N _ (3) at T _ (2), and that in group N _ (3) was significantly lower at T _ (3) than that in group N _ (3) at T _ (3). The difference was statistically significant (P < 0.05). The Sp / O _ 2 was significantly lower in group T _ 1 than that in group P, and lower than that in other groups at T _ (2), P _ (0.05) at T _ (3) and N _ (1). The difference was statistically significant (P < 0.05). Compared with group P, the induction dose, total dose, unit time dose and NRS score of propofol in group N _ 2 and N _ 3 were significantly reduced, and the recovery time of anesthesia in group N _ 1, N _ 2 and N _ 3 were significantly shorter than those in group N _ 2 and N _ 3 (P < 0.05). Compared with N1 group, propofol induction dose, total dose, unit time dose and NRS score of N _ 2N _ 3 group were significantly decreased, and the anaesthesia recovery time was significantly shortened (P < 0.05). The induced dose of propofol and the total dose of propofol in group N _ 3 were significantly lower than those in group N _ 2, and the difference was statistically significant (P 0.05). Compared with group P, the incidence of dizziness in group N 3 was significantly higher than that in group P, and the incidence of hypoxemia in group N 3 was significantly higher than that in group N 1 and group N 2 (P 0.05). Conclusion the combination of naporphine and propofol at 0. 10 mg/kg for hysteroscopic surgery can not only achieve good anaesthesia and analgesia effect, but also have high safety.
【作者單位】： 遼寧中醫(yī)藥大學(xué)附屬醫(yī)院麻醉科;
【分類號(hào)】：R614

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