瑞芬太尼与芬太尼复合羟考酮对宫腔镜手术患者麻醉效果及安全性分析
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摘要
目的探讨瑞芬太尼与芬太尼复合羟考酮在宫腔镜手术中的应用效果。方法选取2015年4月至2017年4月在首都医科大学附属北京妇产医院行宫腔镜手术治疗的患者,采用随机双盲法分为研究组与对照组,对照组予芬太尼复合羟考酮进行麻醉,研究组予瑞芬太尼复合羟考酮进行麻醉,观察经不同麻醉方式后的麻醉效果。结果 78例患者纳入本研究,研究组40例,对照组38例。研究组麻醉镇静效果显著优于对照组,麻醉起效时间、苏醒时间及定向力恢复时间明显短于对照组(P<0.05),术后腹部视觉模拟疼痛评分(visual analogue score, VAS)显著低于对照组(P<0.05);研究组术中及术后10 min的HR、SpO_2、DBP、SBP水平较检查前比较差异无统计学意义(P>0.05);对照组术中及术后10min的HR、SpO_2、DBP和SBP均有不同程度降低或上升,与术前比较差异有统计学意义(P<0.05);研究组不良反应发生率(5.00%)明显低于对照组(21.05%,P<0.05)。结论宫腔镜手术中给予瑞芬太尼复合羟考酮进行麻醉的麻醉镇静效果显著,能明显缩短麻醉起效时间、患者苏醒时间及定向力恢复时间,缓解患者术后腹痛情况,且患者术中生命体征稳定,不良反应较少,值得临床推广应用。
Objective To investigate the effect and safety of remifentanil and fentanyl combined oxycodone in hysteroscopic surgery. Methods The patients who underwent hysteroscopic surgery from April 2015 to April 2017 were enrolled in the study. The control group was received fentanyl and oxycodone for anesthesia, the study group was received remifentanil and oxycodone for anesthesia. The anesthetic effects of two groups after different anesthetic methods were observed. Results Seventy-eight patients were enrolled in the study, 40 cases in the study group and 38 cases in the control group. The anesthetic and sedative effect of the study group was significantly better than that of the control group(P < 0.05). The anesthetic onset time, recovery time, and orientation recovery time were significantly shorter in the study group than those in the control group(P < 0.05). Abdominal VAS in the study group were significantly lower than those in the control group(P < 0.05); the levels of HR, SpO_2, DBP, and SBP at 10 min were not significantly different from those before the examination(P > 0.05); the levels of HR, SpO_2, DBP, and SBP in the control group decreased or increased in different degrees during and after the operation in the control group, which were significantly different with those before the operation(P < 0.05); the incidence of adverse reactions in the study group(5.00%) was significantly lower than that in the control group(21.05%, P < 0.05). Conclusions The effect of anesthesia with sedation of remifentanil and oxycodone during hysteroscopic surgery is significant, which can significantly shorten the onset time of anesthesia, awakening time and recovery time of orientation, relieve abdominal pain,and maintain vital signs stable during surgery. Anesthesia with emifentanil and oxycodone in hysteroscopic surgery is worthy of clinical application.
Objective To investigate the effect and safety of remifentanil and fentanyl combined oxycodone in hysteroscopic surgery. Methods The patients who underwent hysteroscopic surgery from April 2015 to April 2017 were enrolled in the study. The control group was received fentanyl and oxycodone for anesthesia, the study group was received remifentanil and oxycodone for anesthesia. The anesthetic effects of two groups after different anesthetic methods were observed. Results Seventy-eight patients were enrolled in the study, 40 cases in the study group and 38 cases in the control group. The anesthetic and sedative effect of the study group was significantly better than that of the control group(P < 0.05). The anesthetic onset time, recovery time, and orientation recovery time were significantly shorter in the study group than those in the control group(P < 0.05). Abdominal VAS in the study group were significantly lower than those in the control group(P < 0.05); the levels of HR, SpO_2, DBP, and SBP at 10 min were not significantly different from those before the examination(P > 0.05); the levels of HR, SpO_2, DBP, and SBP in the control group decreased or increased in different degrees during and after the operation in the control group, which were significantly different with those before the operation(P < 0.05); the incidence of adverse reactions in the study group(5.00%) was significantly lower than that in the control group(21.05%, P < 0.05). Conclusions The effect of anesthesia with sedation of remifentanil and oxycodone during hysteroscopic surgery is significant, which can significantly shorten the onset time of anesthesia, awakening time and recovery time of orientation, relieve abdominal pain,and maintain vital signs stable during surgery. Anesthesia with emifentanil and oxycodone in hysteroscopic surgery is worthy of clinical application.
引文
[1]卢巧玲,周洁,叶华民,等.宫腔镜手术中舒芬太尼与瑞芬太尼复合丙泊酚麻醉的效果对比[J].中国生化药物杂志,2017,37:106-107.
[2]Hsu WH,Wang SS,Shih HY,et al.Low effect-site concentration of propofol target-controlled infusion reduces the risk of hypotension during endoscopy in a Taiwanese population[J].J Dig Dis,2013,14:147-152.
[3]蓝扬,姚吉.比较舒芬太尼与瑞芬太尼复合异丙酚麻醉在宫腔镜电切术中的效果[J].中国医药指南,2015,13:43-44.
[4]林伦刚.舒芬太尼与瑞芬太尼复合丙泊酚全凭静脉麻醉用于神经外科手术效果与安全性的系统评价[J].中国社区医师,2017,33:53-54.
[5]张小伟,张艳花,付玉杰.羟考酮联合丙泊酚在无痛宫腔镜人流术中的麻醉效果与安全性观察[J].中国医药指南,2016,14:186-187.
[6]姜娜,杨敏.羟考酮复合丙泊酚用于宫腔镜手术麻醉安全性和效果研究[J].中国生化药物杂志,2017,37:211-212.
[7]杨武,陈小丽,袁东彬,等.舒芬太尼与瑞芬太尼复合丙泊酚在宫腔镜手术中效果比较[J].当代医学,2015,21:128-129.
[8]汤霆,张柏银.丙泊酚复合羟考酮静脉麻醉在妇科宫腔镜手术中的应用[J].心理医生,2015,21:108-109.
[9]Puri GD,Matthew PJ,Biswas I,et al.A multicenter evaluation of a closed-loop anesthesia delivery system:a randomized controlled trial[J].Anesth Analg,2016,122:106-114.
[10]李冰,贾俊香.Narcotrend监测TCI丙泊酚复合舒芬太尼或TCI瑞芬太尼在宫腔镜手术中的应用[J].现代医药卫生,2016,32:3458-3461.
[11]缪项慧,李和,姜辉,等.不同剂量羟考酮复合丙泊酚对宫腔镜手术的麻醉效果[J].温州医科大学学报,2017,47:748-751.
[12]金春姬,邹吉贺.瑞芬太尼、舒芬太尼复合丙泊酚静脉靶控麻醉在脑外科手术中的疗效分析及对血清应激相关激素水平的影响[J].国际麻醉学与复苏杂志,2016,37:10-14.
[13]朱海琴,乔建军,赵勇东,等.靶控瑞芬太尼和舒芬太尼分别复合丙泊酚用于宫腔镜手术麻醉效果分析[J].医学理论与实践,2016,29:1922-1923.2018-05-02
[2]Hsu WH,Wang SS,Shih HY,et al.Low effect-site concentration of propofol target-controlled infusion reduces the risk of hypotension during endoscopy in a Taiwanese population[J].J Dig Dis,2013,14:147-152.
[3]蓝扬,姚吉.比较舒芬太尼与瑞芬太尼复合异丙酚麻醉在宫腔镜电切术中的效果[J].中国医药指南,2015,13:43-44.
[4]林伦刚.舒芬太尼与瑞芬太尼复合丙泊酚全凭静脉麻醉用于神经外科手术效果与安全性的系统评价[J].中国社区医师,2017,33:53-54.
[5]张小伟,张艳花,付玉杰.羟考酮联合丙泊酚在无痛宫腔镜人流术中的麻醉效果与安全性观察[J].中国医药指南,2016,14:186-187.
[6]姜娜,杨敏.羟考酮复合丙泊酚用于宫腔镜手术麻醉安全性和效果研究[J].中国生化药物杂志,2017,37:211-212.
[7]杨武,陈小丽,袁东彬,等.舒芬太尼与瑞芬太尼复合丙泊酚在宫腔镜手术中效果比较[J].当代医学,2015,21:128-129.
[8]汤霆,张柏银.丙泊酚复合羟考酮静脉麻醉在妇科宫腔镜手术中的应用[J].心理医生,2015,21:108-109.
[9]Puri GD,Matthew PJ,Biswas I,et al.A multicenter evaluation of a closed-loop anesthesia delivery system:a randomized controlled trial[J].Anesth Analg,2016,122:106-114.
[10]李冰,贾俊香.Narcotrend监测TCI丙泊酚复合舒芬太尼或TCI瑞芬太尼在宫腔镜手术中的应用[J].现代医药卫生,2016,32:3458-3461.
[11]缪项慧,李和,姜辉,等.不同剂量羟考酮复合丙泊酚对宫腔镜手术的麻醉效果[J].温州医科大学学报,2017,47:748-751.
[12]金春姬,邹吉贺.瑞芬太尼、舒芬太尼复合丙泊酚静脉靶控麻醉在脑外科手术中的疗效分析及对血清应激相关激素水平的影响[J].国际麻醉学与复苏杂志,2016,37:10-14.
[13]朱海琴,乔建军,赵勇东,等.靶控瑞芬太尼和舒芬太尼分别复合丙泊酚用于宫腔镜手术麻醉效果分析[J].医学理论与实践,2016,29:1922-1923.2018-05-02