發(fā)布時間：2018-07-11 17:34

  本文選題：舒芬太尼 + 喉罩　； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：[目的]舒芬太尼是一種強(qiáng)效的阿片類麻醉鎮(zhèn)痛藥,為特異性的μ1受體高選擇性的激動劑,具有給藥方便,起效快,對心血管和呼吸系統(tǒng)影響較小,無組胺釋放等特點(diǎn),而廣泛應(yīng)用于臨床麻醉。喉罩是介于面罩和氣管插管之間維持氣道通氣的一種新型通氣工具,它既可選擇性的用于麻醉也可用于急癥困難氣道,操作方便簡單。全麻誘導(dǎo)期間喉罩插管時,對咽喉部刺激比較輕,同時對血流動力學(xué)和應(yīng)激反應(yīng)的影響也較小。以往的研究大多都是通過鎮(zhèn)靜藥、麻醉性鎮(zhèn)痛藥、肌肉松弛藥三者組合來研究喉罩插管對血流的影響,由于有肌肉松弛劑的作用,研究結(jié)果往往特異性差。本研究以BIS指數(shù)作為麻醉深度標(biāo)準(zhǔn),研究應(yīng)用丙泊酚維持在同一麻醉深度下,評價3種不同劑量的舒芬太尼在麻醉誘導(dǎo)喉罩插管期間對血流動力學(xué)的作用比較,為臨床用藥提供更加合適劑量。[方法]采用隨機(jī)、對照和雙盲的研究方法。選擇普外科擇期手術(shù)120例,經(jīng)過充分術(shù)前準(zhǔn)備,選擇ASA分級為Ⅰ至II級的患者,隨機(jī)數(shù)字法分為四組,每組為30例。舒芬太尼組：Ⅰ組(D1組)、Ⅱ組(D2組)及Ⅲ組(D3組)分別給予舒芬太尼0.3、0.4及0.5μg·kg-1。對照組(C組)為4 μg· kg-1芬太尼注射液,四組藥物分別在麻醉誘導(dǎo)時通過靜脈緩慢注入,時間約30秒。4組患者的麻醉誘導(dǎo)、維持過程相同。在注入舒芬太尼或芬太尼之前,四組患者分別靶控注入丙泊酚,并調(diào)節(jié)用藥量,使BIS數(shù)值控制在50±5范圍之內(nèi)。監(jiān)測并記錄各組患者用藥前(TO)、誘導(dǎo)時(T1)、麻醉誘導(dǎo)后2min(T2)、插管即時(T3)、插管后1min(T4)、3min(T5)、5min(T6)、10min(T7),各節(jié)點(diǎn)的血流動力學(xué)參數(shù)的測得值、BIS值、丙泊酚的用量。[結(jié)果]四組患者的一般情況,如性別、年齡、體重、基礎(chǔ)血壓、心電圖、身高等比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),而四組所使用的丙泊酚總量也無明顯的差異性(P0.05)。D1組、D2組及D3組丙泊酚的用量分別為(5.0±1.5)、(5.0±1.1)和(5.1±0.5)mg·kg-1·h-1,C組為(5.0±1.0)mg·kg-1·h-1。在麻醉誘導(dǎo)時D1、D2和D3組與C組相比,D1、D2、D3組患者的血流動力學(xué)參數(shù)波動較較C組小,C組患者的血流動力學(xué)波動比較大。D1、D2、和D3組相比較,D2組血流動力學(xué)更為穩(wěn)定�；颊咴谒慕M中均未見嚴(yán)重不良反應(yīng)。[結(jié)論]舒芬太尼比芬太尼在麻醉誘導(dǎo)期喉罩插管中有更好的血流動力學(xué)穩(wěn)定性,隨著使用劑量的逐漸增加,可相應(yīng)地減少麻醉誘導(dǎo)期丙泊酚的使用總量。靶控輸注丙泊酚使誘導(dǎo)期BIS值在(50±5),復(fù)合0.4 μg·kg-1舒芬太尼,能更好的維持血流動力學(xué)的穩(wěn)定。
[Abstract]:[objective] Sufentanil is a powerful opioid analgesics and analgesics. It is a highly selective agonist of specific 渭 1 receptor. It has the advantages of convenient administration, rapid onset, little effect on cardiovascular and respiratory system, and no histamine release. And widely used in clinical anesthesia. Laryngeal mask is a new type of ventilation tool between mask and tracheal intubation. It can be used in anesthesia and emergency airway easily and easily. During laryngeal mask intubation during general anesthesia induction, the stimulation of pharynx and larynx was relatively light, and the effect on hemodynamics and stress response was also small. Most of the previous studies have studied the effects of laryngeal mask intubation on blood flow through the combination of sedatives, anaesthetic analgesics and muscle relaxants. Because of the effect of muscle relaxants, the results are often not specific. In this study, the BIS index was used as the standard of anesthetic depth to evaluate the hemodynamic effects of three different doses of sufentanil during the induction of laryngeal mask intubation by using propofol to maintain the same anesthetic depth. To provide a more appropriate dose for clinical use. [methods] A randomized, controlled and double blind study was used. 120 patients with elective surgery in general surgery were selected, and 30 patients with ASA grade 鈪，

本文編號：2116046