Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。
Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
目的 观察右美托咪啶复合舒芬太尼用于经腹子宫全切术后患者自控静脉镇痛（PCIA）的效果。 方法 2011年3月－2012年6月选择经腹子宫全切术患者90例，年龄39～68岁，体重48～72 kg，美国麻醉医师协会分级Ⅰ～Ⅱ级。采用随机数字表法，将患者随机分为3组，每组各30例。于手术结束即刻行PCIA。对照组（C组）采用舒芬太尼150 μg+昂丹司琼12 mg；S1组采用右美托咪定200 μg+舒芬太尼100 μg+昂丹司琼12 mg；S2组采用右美托咪定200 μg+舒芬太尼150 μg+昂丹司琼12 mg。3组均用生理盐水稀释至100 mL，负荷剂量均为舒芬太尼0.1 μg/kg，静脉镇痛泵背景输注速度2 mL/h，自控给药剂量0.5 mL，锁定时间15 min。记录术后6、12、24和48 h Ramsay镇静评分和视觉模拟评分（VAS），记录不良反应发生情况和患者对术后镇痛的满意度。 结果 3组患者均能获得较好的镇痛效果。其中C组VAS评分较低，但恶心、呕吐、皮肤瘙痒发生率升高；与C组相比，Sl组和S2组Ramsay镇静评分升高，恶心、呕吐、皮肤瘙痒发生率降低，患者满意度升高。S1组患者满意度最高；S2组VAS评分最低。3组均未发生心动过缓、低血压、过度镇静和呼吸抑制。 结论 右美托咪啶可增加经腹子宫全切术患者术后舒芬太尼自控静脉镇痛的效果，提高患者满意度，降低不良反应。
【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组，术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼；B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼；C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼，观察三组患者的术后镇痛效果（视觉模拟法评分，即VAS评分）及不良反应。 结果 A组VAS评分高于B组和C组，B组VAS评分高于C组（Plt;0.05）。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异（Pgt;0.05）。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小，患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
目的 观察帕瑞昔布钠与舒芬太尼用于无痛胃镜麻醉的安全性和有效性及对患者满意度的影响，为提高临床无痛胃镜麻醉的安全性和舒适性提供依据。 方法 采取前瞻性随机双盲对照方法，纳入2011年8月－12月拟行无痛胃镜检查的患者120例，随机分为3组。患者于胃镜检查开始前口服利多卡因胶浆，静脉注射舒芬太尼、帕瑞昔布钠或生理盐水10 mL。检查时静脉注射异丙酚。记录患者检查过程中生命体征、异丙酚使用量、诱导时间、检查时间、苏醒时间、医师以及患者满意度、舒适度等数据。 结果 舒芬太尼组检查中各时间点平均动脉压明显低于帕瑞昔布组（P=0.029），血管活性药物用量明显高于帕瑞昔布组（P=0.036）。医师以及患者满意度舒芬太尼组和帕瑞昔布组相当，且均高于对照组（P＜0.05）。除呛咳外，帕瑞昔布组其他不良反应的发生率明显低于舒芬太尼组（P＜0.05）。 结论 实施无痛胃镜检查前15 min静脉注射帕瑞昔布钠0.6 mg/kg或舒芬太尼0.10 μg/kg均可以获得满意的麻醉效果，麻醉医师和患者及家属的满意度明显增高，且帕瑞昔布对呼吸和循环的影响更小，安全性更高。
【摘要】 目的 观察依托咪酯乳剂复合舒芬太尼用于全麻下喉罩置入的血流动力学变化。 方法 选择2009年4月-2010年2月间，46例需全麻手术、适合使用喉罩，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级，年龄18～60岁的患者，随机分为两组:依托咪酯乳剂组（E组）23 例，静脉推注咪达唑仑0.05 mg/kg，依托咪酯乳剂0.3 mg/kg；依托咪酯乳剂+舒芬太尼组（ES组）23 例，静脉推注咪达唑仑0.05 mg/kg，依托咪酯乳剂0.15 mg/kg，加舒芬太尼0.5 mg/kg，诱导后置入喉罩，记录患者诱导前、用药后1 min、喉罩置入后1 min的心率（HR）、平均动脉压（MAP）以及评估喉罩置入条件的6项指标（张口困难分级、置入喉罩困难分级、舌咽反射、干咳干呕反射、肢动反应及喉痉挛分级），同时记录呼吸暂停时间。 结果 ES组能提供更好的喉罩置入条件，且能减少舌咽反射和肢体反应， 更能保证喉罩置入时血流动力学的稳定。 结论 依托咪酯乳剂复合舒芬太尼能为全麻喉罩置入时提供更好的条件，且能保证更好的血流动力学稳定。【Abstract】 Objective To investigate the hemodynamics changes when etomidate combined with sufentanil was applied for laryngeal mask airway insertion under the general anaesthesia. Methods From April 2009 to February 2010, 46 patients requiring general anesthesia using laryngeal mask airway (LMA) (American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ) aged 18-60 were randomly divided into two groups: 23 in etomidate emulsion group (group E) underwent the intravenous injection with midazolm (0.3 mg/kg) and etomidate (0.05 mg/kg); 23 in etomidate emulsion + sufentanil group (group ES) underwent the intravenous injection with etomidate (0.15 mg/kg), midazolm (0.05 mg/kg), and sufentanil 0.5 mg/kg. The patients were evaluated by six indexes of LMA insertion (mouth opening, swallowing reflex, cough reflex,vomiting reflex, body motion, and laryngospasm classification). After the anesthesia induction, LMA was inserted. The blood pressure (BP), heart rate (HR), and mean arterial pressure (MAP) were recorded before anesthesia induction one minute after the injection and one minute after LMA insertion. Meanwhile, the apnea time was recorded. Results Compared with group E, group ES offered better anesthesia for LMA insertion, less swallowing reflex and body motion, and more stable haemodynamics. Conclusion Etomidate combined with sufentanil provides good condition for LMA insertion under the general anaesthesia with steady haemodynamics.
目的:观察舒芬太尼复合异丙酚自控镇静镇痛在结肠镜检查中的效果及不良反应,从而探讨该方法的安全性和有效性。方法:行无痛纤维结肠镜检查的患者60例,随机分为两组:自控镇痛/镇静组和静脉复合全麻醉组,每组30例。自控镇痛/镇静组首先缓慢静脉注射舒芬太尼0.12 μg/kg,随之接电子自控镇痛泵,负荷量设定为0.5 mg/kg,以4 mg/kg·h的速度持续泵入异丙酚(10 mg/mL),术中按压1次自控手柄可快速推注异丙酚1 mL。静脉复合全麻醉组首先静脉缓慢推注芬太尼1 μg/kg,咪唑安定0.02 mg/kg, 2 min后缓慢推注异丙酚0.8～1 mg/kg。术中间断给予异丙酚以维持听觉诱发电位指数(AAI)于30～40之间。结果:静脉复合全麻醉组的MAP较检查前明显下降且较自控镇痛/镇静组下降更为明显且具有统计学意义(Plt;0.05)。自控镇痛/镇静组的呼吸频率较静脉复合全麻醉组下降明显且在T3时间点具有统计学意义(Plt;0.05)。自控镇痛/镇静组患者OAA/S评分达5分和Aldrete评分达9分的时间均较静脉复合全麻醉组明显缩短(1.4±1.3 VS 3.9±1.7和 2.9±1.7 VS 5.7±1.7)(Plt;0.05)。两组的内镜医师和患者满意度评分无统计学差异(P＞0.05)。结论:自控镇静镇痛能够比传统的静脉全身麻醉提供更良好的循环系统稳定性,更迅速的麻醉后恢复,是结肠镜检查镇静镇痛的理想和安全方法。
【摘要】目的观察低浓度罗哌卡因复合舒芬太尼用于分娩镇痛的效果。方法2007年5月8月按入选标准选择100例产妇,随机分成试验组和对照组,每组50例。试验组分娩前给予低浓度罗哌卡因加舒芬太尼,对照组不行无痛分娩,通过视觉模拟评分法等指标观察镇痛效果。结果试验组镇痛后视觉模拟评分较对照组低(Plt;0.05);两组镇痛期间血压、心率差异有统计学意义（Plt;0.05），新生儿Apgar评分比较无统计学意义(Pgt;0.05)。结论联合应用罗哌卡因和舒芬太尼用于硬膜外分娩镇痛能取得较好的效果,值得在临床中推广应用。
【摘要】 目的 比较舒芬太尼与等效剂量芬太尼在髋关节置换术后患者硬膜外镇痛的临床效果。 方法 2006年11月-2008年9月收治的50例硬膜外麻醉下髋关节置换术患者，随机分为两组（n=25）。芬太尼组（A组）:芬太尼0.75 mg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL；舒芬太尼组（B组），舒芬太尼75 μg加0.894%甲磺酸哌卡因20 mL加生理盐水至100 mL硬膜外镇痛。其中，A组患者于手术结束时，静脉滴注格拉司琼3 mg。持续剂量2 mL/h，单次给药量（PCA）0.5 mL/次，锁定时间15 min。观察两组的镇痛效果，恶心、呕吐次数，记录脉搏血氧饱和度、心率、呼吸的变化。 结果 镇痛泵开机后，B组各时段镇静评分，2分以上者明显多于A组，镇痛评分明显低于A组，有统计学意义（Plt;0.05），两组术后恶心、呕吐发生率都较低，组间差异无统计学意义（Pgt;0.05）。两组4、12、24 h的呼吸频率和脉搏血氧饱和度差异有统计学意义（Plt;0.05），但48 h的呼吸频率和脉搏血氧饱和度无统计学意义（Pgt;0.05）。 结论 在等效剂量下，髋关节置换术后患者硬膜外镇痛，舒芬太尼明显优于芬太尼。【Abstract】 Objective To compare the clinical effect of epidural analgesia with sufentanil and fentanyl in an equivalent dose after hip replacement. Methods From December 2006 to September 2008, fifty cases of epidural anesthesia after hip replacement were randomly divided into two groups, each group had 25 cases. Group A (fentanyl group): fentanyl mesylate 0.75 mg+0.894% ropivacaine 20 mL+0.9% sodium chloride solution to 100 mL; group B (sufentanil group): sufentanil 75 μg+0.894% ropivacaine mesylate 20 mL+0.9% sodium chloride solution to 100 mL epidural analgesia. Patients in group A received intravenous infusion of granisetron 3 mg at the end of surgery. Continuous dose was 2 mL/h, with the volume of single dose (PCA) 0.5 mL per time and lockout time of 15 minutes. The analgesic effect, nausea, and vomiting frequency were observed, and the pulse oxygen saturation, heart rate, and breathing changes were recorded. Results After boot analgesia, S sedation scores for each phase and pain score in group B were significantly different compared with those in group A (Plt;0.05). Both groups had low incidence of nausea and vomiting, and the difference was not statistically significant (Pgt;0.05). The difference of respiratory rate and pulse oxygen saturation at 4 h, 12 h, 24 h was statistically significant between two groups (Plt;0.05), but at 48 h the difference was not significant (Pgt;0.05). Conclusion In the equivalent dose, epidural analgesia with sufentanil in the patients with hip replacement is superior to fentanyl.